Objective Cardiovascular complications contribute to postoperative morbidity and mortality in elderly hip fracture patients. Limited data are available regarding which preoperative risk factors predict cardiovascular ...Objective Cardiovascular complications contribute to postoperative morbidity and mortality in elderly hip fracture patients. Limited data are available regarding which preoperative risk factors predict cardiovascular course following hip fracture surgery （HFS）. We used high sensitive troponin I （hs-TnI） assays and clinical parameters to identify preoperative risk factors associated with major adverse cardiac events （MACE） in elderly hip frac^u＇e patients. Method From August 2014 to November 2016, 575 patients with hip fracture were enrolled in a retrospective, single-center registry. A total of 262 of these patients underwent HFS and hs-TnI assays. MACE was defined as postoperative all-cause deaths, heart failure （HF）, new-onset atrial fibrillation （AF）, myocardial infarction （MI） and cardiovascular re-hospitalization that occurred within 90 days postoperative. Results Of 262 HFS patients, MACE developed following HFS in 65 （24.8%）. Patients with MACE were older and had higher rates of renal insufficiency, coronary artery disease, prior HF, low left ventricular ejection fraction and use of beta blockers; higher levels of hs-Tnl and N-terminal pro-brain natriuretic peptide （NT-proBNP） and higher revised cardiac risk index. A preoperative hs-TnI≥ 6.5 ng/L was associated with high risk of postoperative HF, new-onset AF and MACE. In multivariable analysis, pre-operative independent predictors for MACE were age 〉 80 years [adjusted hazard ratio （HR）： 1.79, 95% confident interval （CI）： 1.03-3.13, P = 0.04], left ventricular ejection fraction （LVEF） 〈 50% （adjusted HR： 3.17, 95% CI： 1.47-5.82, P 〈 0.01） and hs-TnI 〉 6.5 ng/L （adjusted HR： 3.75, 95% CI： 2.09~5.17, P 〈 0.01）. Conclusion In elderly patients with hip fracture who undergo HFS, a preoperative assessment of hs-TnI may help the risk refinement of cardiovascular complications.展开更多
BACKGROUND The care discrepancy for patients presenting to a hospital on the weekend relative to the work week is well documented.With respect to hip fractures,however,there is no consensus about the presence of a so-...BACKGROUND The care discrepancy for patients presenting to a hospital on the weekend relative to the work week is well documented.With respect to hip fractures,however,there is no consensus about the presence of a so-called“weekend effect”.This study sought to determine the effects,if any,of weekend admission on care of geriatric hip fractures admitted to a large tertiary care hospital.It was hypothesized that geriatric hip fracture patients admitted on a weekend would have longer times to medical optimization and surgery and increased complication and mortality rates relative to those admitted on a weekday.AIM To determine if weekend admission of geriatric hip fractures is associated with poor outcome measures and surgical delay.METHODS A retrospective chart review of operative geriatric hip fractures treated from 2015-2017 at a large tertiary care hospital was conducted.Two cohorts were compared:patients who arrived at the emergency department on a weekend,and those that arrived at the emergency department on a weekday.Primary outcome measures included mortality rate,complication rate,transfusion rate,and length of stay.Secondary outcome measures included time from emergency department arrival to surgery,time from emergency department arrival to medical optimization,and time from medical optimization to surgery.RESULTS There were no statistically significant differences in length of stay(P=0.2734),transfusion rate(P=0.9325),or mortality rate(P=0.3460)between the weekend and weekday cohorts.Complication rate was higher in patients who presented on a weekend compared to patients who presented on a weekday(13.3%vs 8.3%;P=0.044).Time from emergency department arrival to medical optimization(22.7 h vs 20.0 h;P=0.0015),time from medical optimization to surgery(13.9 h vs 10.8 h;P=0.0172),and time from emergency department arrival to surgery(42.7 h vs 32.5 h;P<0.0001)were all significantly longer in patients who presented to the hospital on a weekend compared to patients who presented to the hospital on a weekday.CONCLUSION This study provided insight into the“weekend effect”for geriatric hip fractures and found that day of presentation has a clinically significant impact on delivered care.展开更多
目的探讨糖化血红蛋白变异指数(HGI)在评价老年2型糖尿病合并髋部骨折术后肺部感染的临床价值。方法收集2021年1月-2023年4月在同济大学附属上海市第四人民医院行手术治疗的142例老年2型糖尿病合并髋部骨折患者的临床资料,依据术后是否...目的探讨糖化血红蛋白变异指数(HGI)在评价老年2型糖尿病合并髋部骨折术后肺部感染的临床价值。方法收集2021年1月-2023年4月在同济大学附属上海市第四人民医院行手术治疗的142例老年2型糖尿病合并髋部骨折患者的临床资料,依据术后是否发生肺部感染分为肺部感染组和非肺部感染组,通过电子病历收集2组患者围术期临床资料并进行单因素分析,采用多因素Logistic回归分析术后肺部感染的相关因素。绘制受试者工作特征(Receiver operating characteristic,ROC)曲线分析HGI对术后肺部感染的预测价值。结果与非肺部感染组比较,肺部感染组吸烟史比例高,糖尿病病程和卧床时间长,血清白蛋白水平低,术中出血量多,空腹血糖、糖化血红蛋白(HbA1c)和HGI水平较高,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,糖尿病病程、卧床时间、空腹血糖、HbA1c和HGI是髋关节术后肺部感染的独立危险因素(P<0.05)。血清白蛋白是保护性因素(P<0.05)。ROC分析显示,HGI预测术后肺部感染的曲线下面积(Area Under the Curv,AUC)为0.912,明显高于空腹血糖、HbA1c的0.654和0.817(Z=4.289,P<0.05),最佳截断值为0.52%,灵敏度和特异度分别为87.21%和85.79%,提示具有良好的诊断效能。以最佳截断值为切入点将患者分为2组,高HGI组中肺部感染发生率(36.11%)显著高于低HGI组(12.86%),差异有统计学意义(P<0.05)。结论高HGI的老年2型糖尿病合并髋部骨折患者术后发生肺部感染的风险越大,其预测术后肺部感染的价值优于空腹血糖和HbA1c等传统血糖指标,临床应当密切监测HGI的变化,以更好的用于术后肺部感染的风险评估。展开更多
Background Diabetes has been associated with increased risk of fracture and impaired fracture healing. The aim of this study was to examine the influence of diabetes on perioperative complications, length of stay and ...Background Diabetes has been associated with increased risk of fracture and impaired fracture healing. The aim of this study was to examine the influence of diabetes on perioperative complications, length of stay and ambulatory ability recovery in individuals with hip fracture, and to determine whether changes could be made to improve treatment outcome. Methods The study included 707 hip fracture patients treated at Beijing Jishuitan Hospital between July 2009 and December 2010. The medical history and perioperative complications were compared between non-diabetic and diabetic groups. Length of stay, days awaiting surgery, and days of hospitalization after surgery were also analyzed. Ambulatory ability was compared at 1-year follow-up using the Chi-square test and Fisher＇s exact test. An independent Student＇s t-test was used to compare normally distributed continuous data. Results Patients with diabetes were more likely than non-diabetic patients to develop cardiac perioperative complications （8.9% vs. 3.0%, P=0.021）, urinary tract infections （12.0% vs. 2.8%, P 〈0.001）, and gastrointestinal symptoms （15.0% vs. 6.8%, P=0.003）. No difference in perioperative complications was observed between the groups. Days awaiting surgery and length of hospital stay were both longer in the diabetic group （（8.0＋5.1） vs. （6.2＋3.7） days and （16.5＋3.8） vs. （13.3＋3.8） days, P 〈0.001, respectively）. Before the occurrence of fracture, patients with diabetes were less likely to be ambulatory outdoors （71.9% vs. 85.9%, P 〈0.001） and had more restricted walking ability. After at least 1-year follow-up, similar proportions of patients in the non-diabetic and diabetic groups （16.1% and 15.9%, respectively）, who were able to ambulate outdoors before the fracture, became housebound till the final follow-up. Conclusions Diabetics are at increased risk of specific complications and have a longer time to surgery and longer in-hospital stay, but generally have similar recovery to non-diabetics thereafter.展开更多
[目的]比较动力髋螺钉（dynamic hip screw，DHS）、髓内钉、多枚钉3种内固定方法治疗老年人髋部骨折的疗效。[方法]1997年6月～2003年6月共收治60岁以上老年人髋部骨折患者178例。行手术内固定治疗128例，96例获得12～83个月（平均41．...[目的]比较动力髋螺钉（dynamic hip screw，DHS）、髓内钉、多枚钉3种内固定方法治疗老年人髋部骨折的疗效。[方法]1997年6月～2003年6月共收治60岁以上老年人髋部骨折患者178例。行手术内固定治疗128例，96例获得12～83个月（平均41．5个月）的随访，通过病例复习和随访，获得以下资料包括年龄、性别、手术方式、助能恢复及并发症发生情况。分别按手术方式、年龄分组比较其疗效和并发症发生情况。通过计算发生并发症患者的平均年龄，对手术风险性进行预测。[结果]本组96例，术后功能恢复良好79例，可及差17例；良好率82．3％。术后发生并发症11例，发生率11．5％，其中术后早期诱发原有合并症3例。DHS内固定组和髓内钉内固定组的功能恢复明显优于多枚钉内固定组（P〈0．05）；70岁以上年龄组功能恢复明显差于70岁以下年龄组；以上比较均有统计学意义。11例发生并发症患者的平均年龄为82岁。其中术后早期诱发原有合并症的3例患者平均年龄为92岁．[结论]老年人髋部骨折因合理选择内固定材料，动力髋螺钉、髓内钉为首选，适用于各种不同类型的骨折。展开更多
文摘Objective Cardiovascular complications contribute to postoperative morbidity and mortality in elderly hip fracture patients. Limited data are available regarding which preoperative risk factors predict cardiovascular course following hip fracture surgery （HFS）. We used high sensitive troponin I （hs-TnI） assays and clinical parameters to identify preoperative risk factors associated with major adverse cardiac events （MACE） in elderly hip frac^u＇e patients. Method From August 2014 to November 2016, 575 patients with hip fracture were enrolled in a retrospective, single-center registry. A total of 262 of these patients underwent HFS and hs-TnI assays. MACE was defined as postoperative all-cause deaths, heart failure （HF）, new-onset atrial fibrillation （AF）, myocardial infarction （MI） and cardiovascular re-hospitalization that occurred within 90 days postoperative. Results Of 262 HFS patients, MACE developed following HFS in 65 （24.8%）. Patients with MACE were older and had higher rates of renal insufficiency, coronary artery disease, prior HF, low left ventricular ejection fraction and use of beta blockers; higher levels of hs-Tnl and N-terminal pro-brain natriuretic peptide （NT-proBNP） and higher revised cardiac risk index. A preoperative hs-TnI≥ 6.5 ng/L was associated with high risk of postoperative HF, new-onset AF and MACE. In multivariable analysis, pre-operative independent predictors for MACE were age 〉 80 years [adjusted hazard ratio （HR）： 1.79, 95% confident interval （CI）： 1.03-3.13, P = 0.04], left ventricular ejection fraction （LVEF） 〈 50% （adjusted HR： 3.17, 95% CI： 1.47-5.82, P 〈 0.01） and hs-TnI 〉 6.5 ng/L （adjusted HR： 3.75, 95% CI： 2.09~5.17, P 〈 0.01）. Conclusion In elderly patients with hip fracture who undergo HFS, a preoperative assessment of hs-TnI may help the risk refinement of cardiovascular complications.
文摘BACKGROUND The care discrepancy for patients presenting to a hospital on the weekend relative to the work week is well documented.With respect to hip fractures,however,there is no consensus about the presence of a so-called“weekend effect”.This study sought to determine the effects,if any,of weekend admission on care of geriatric hip fractures admitted to a large tertiary care hospital.It was hypothesized that geriatric hip fracture patients admitted on a weekend would have longer times to medical optimization and surgery and increased complication and mortality rates relative to those admitted on a weekday.AIM To determine if weekend admission of geriatric hip fractures is associated with poor outcome measures and surgical delay.METHODS A retrospective chart review of operative geriatric hip fractures treated from 2015-2017 at a large tertiary care hospital was conducted.Two cohorts were compared:patients who arrived at the emergency department on a weekend,and those that arrived at the emergency department on a weekday.Primary outcome measures included mortality rate,complication rate,transfusion rate,and length of stay.Secondary outcome measures included time from emergency department arrival to surgery,time from emergency department arrival to medical optimization,and time from medical optimization to surgery.RESULTS There were no statistically significant differences in length of stay(P=0.2734),transfusion rate(P=0.9325),or mortality rate(P=0.3460)between the weekend and weekday cohorts.Complication rate was higher in patients who presented on a weekend compared to patients who presented on a weekday(13.3%vs 8.3%;P=0.044).Time from emergency department arrival to medical optimization(22.7 h vs 20.0 h;P=0.0015),time from medical optimization to surgery(13.9 h vs 10.8 h;P=0.0172),and time from emergency department arrival to surgery(42.7 h vs 32.5 h;P<0.0001)were all significantly longer in patients who presented to the hospital on a weekend compared to patients who presented to the hospital on a weekday.CONCLUSION This study provided insight into the“weekend effect”for geriatric hip fractures and found that day of presentation has a clinically significant impact on delivered care.
文摘目的探讨糖化血红蛋白变异指数(HGI)在评价老年2型糖尿病合并髋部骨折术后肺部感染的临床价值。方法收集2021年1月-2023年4月在同济大学附属上海市第四人民医院行手术治疗的142例老年2型糖尿病合并髋部骨折患者的临床资料,依据术后是否发生肺部感染分为肺部感染组和非肺部感染组,通过电子病历收集2组患者围术期临床资料并进行单因素分析,采用多因素Logistic回归分析术后肺部感染的相关因素。绘制受试者工作特征(Receiver operating characteristic,ROC)曲线分析HGI对术后肺部感染的预测价值。结果与非肺部感染组比较,肺部感染组吸烟史比例高,糖尿病病程和卧床时间长,血清白蛋白水平低,术中出血量多,空腹血糖、糖化血红蛋白(HbA1c)和HGI水平较高,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,糖尿病病程、卧床时间、空腹血糖、HbA1c和HGI是髋关节术后肺部感染的独立危险因素(P<0.05)。血清白蛋白是保护性因素(P<0.05)。ROC分析显示,HGI预测术后肺部感染的曲线下面积(Area Under the Curv,AUC)为0.912,明显高于空腹血糖、HbA1c的0.654和0.817(Z=4.289,P<0.05),最佳截断值为0.52%,灵敏度和特异度分别为87.21%和85.79%,提示具有良好的诊断效能。以最佳截断值为切入点将患者分为2组,高HGI组中肺部感染发生率(36.11%)显著高于低HGI组(12.86%),差异有统计学意义(P<0.05)。结论高HGI的老年2型糖尿病合并髋部骨折患者术后发生肺部感染的风险越大,其预测术后肺部感染的价值优于空腹血糖和HbA1c等传统血糖指标,临床应当密切监测HGI的变化,以更好的用于术后肺部感染的风险评估。
文摘Background Diabetes has been associated with increased risk of fracture and impaired fracture healing. The aim of this study was to examine the influence of diabetes on perioperative complications, length of stay and ambulatory ability recovery in individuals with hip fracture, and to determine whether changes could be made to improve treatment outcome. Methods The study included 707 hip fracture patients treated at Beijing Jishuitan Hospital between July 2009 and December 2010. The medical history and perioperative complications were compared between non-diabetic and diabetic groups. Length of stay, days awaiting surgery, and days of hospitalization after surgery were also analyzed. Ambulatory ability was compared at 1-year follow-up using the Chi-square test and Fisher＇s exact test. An independent Student＇s t-test was used to compare normally distributed continuous data. Results Patients with diabetes were more likely than non-diabetic patients to develop cardiac perioperative complications （8.9% vs. 3.0%, P=0.021）, urinary tract infections （12.0% vs. 2.8%, P 〈0.001）, and gastrointestinal symptoms （15.0% vs. 6.8%, P=0.003）. No difference in perioperative complications was observed between the groups. Days awaiting surgery and length of hospital stay were both longer in the diabetic group （（8.0＋5.1） vs. （6.2＋3.7） days and （16.5＋3.8） vs. （13.3＋3.8） days, P 〈0.001, respectively）. Before the occurrence of fracture, patients with diabetes were less likely to be ambulatory outdoors （71.9% vs. 85.9%, P 〈0.001） and had more restricted walking ability. After at least 1-year follow-up, similar proportions of patients in the non-diabetic and diabetic groups （16.1% and 15.9%, respectively）, who were able to ambulate outdoors before the fracture, became housebound till the final follow-up. Conclusions Diabetics are at increased risk of specific complications and have a longer time to surgery and longer in-hospital stay, but generally have similar recovery to non-diabetics thereafter.
文摘[目的]比较动力髋螺钉（dynamic hip screw，DHS）、髓内钉、多枚钉3种内固定方法治疗老年人髋部骨折的疗效。[方法]1997年6月～2003年6月共收治60岁以上老年人髋部骨折患者178例。行手术内固定治疗128例，96例获得12～83个月（平均41．5个月）的随访，通过病例复习和随访，获得以下资料包括年龄、性别、手术方式、助能恢复及并发症发生情况。分别按手术方式、年龄分组比较其疗效和并发症发生情况。通过计算发生并发症患者的平均年龄，对手术风险性进行预测。[结果]本组96例，术后功能恢复良好79例，可及差17例；良好率82．3％。术后发生并发症11例，发生率11．5％，其中术后早期诱发原有合并症3例。DHS内固定组和髓内钉内固定组的功能恢复明显优于多枚钉内固定组（P〈0．05）；70岁以上年龄组功能恢复明显差于70岁以下年龄组；以上比较均有统计学意义。11例发生并发症患者的平均年龄为82岁。其中术后早期诱发原有合并症的3例患者平均年龄为92岁．[结论]老年人髋部骨折因合理选择内固定材料，动力髋螺钉、髓内钉为首选，适用于各种不同类型的骨折。
