Clinical characteristics and factors influencing waiting time to surgery and length of stay in elderly patients with hip fractures

Автор: Nguyen Nam H., Nguyen Le H., Vu Khoa V., Duong Chinh D., Cao Loi B., Le Anh T.

Журнал: Гений ортопедии @geniy-ortopedii

Рубрика: Оригинальные статьи

Статья в выпуске: 6 т.27, 2021 года.

Бесплатный доступ

Introduction To investigate clinical, laboratory findings and identify pre-operative variables associated with increased waiting time to surgery (WTS) and length of hospital stay (LOS) among hip fracture patients. Material and methods This prospective study is conducted between April 2020 and April 2021. Patients’ information was collected from medical records and subjected to analysis using a univariate and multivariate model. Results The study included 118 patients in a mean age of 79.5 years, and the majority were female (68.6 %). Overall, 66.9 % of the patients had at least one comorbidity. Almost all (95.8 %) patients had fractures due to a low-impact fall and an intertrochanteric fracture was the predominant type (61.9 %). The most abnormal laboratory findings at admission were elevated C-reactive protein (CRP) levels (94.9 %) followed by decreased mineral density (85.1 %), anaemia (81.4 %), electrolyte abnormalities (69.4 %) and hypoalbuminemia (66.1 %). The mean of WTS among 115 patients undergoing surgical treatment was 52.1 ± 47 hours and no patient-related factors had a significant influence on WTS. The mean hospital LOS was 15.9 ± 4.7 days. Marked elevation of CRP level (OR = 3.317, p = 0.042), type of surgery (OR = 4.413, p = 0.005) and WTS (OR = 4.602, p = 0.001) were independent predictors of prolonged LOS. Conclusion Most patients with hip fractures are elderly and suffer from many comorbidities and laboratory abnormalities. No patient-related factors are predictors of WTS but the elevation of CRP, type of surgery and time of waiting to surgery influence the LOS.

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Hip fracture, waiting time to surgery, length of hospital stay, vietnam

Короткий адрес: https://sciup.org/142231592

IDR: 142231592   |   DOI: 10.18019/1028-4427-2021-27-6-686-692

Список литературы Clinical characteristics and factors influencing waiting time to surgery and length of stay in elderly patients with hip fractures

  • Veronese N., Maggi S. Epidemiology and social costs of hip fracture // Injury. 2018. Vol. 49, No 8. P. 1458-1460. DOI: 10.1016/j.injury.2018.04.015.
  • Youm T., Koval K.J., Zuckerman J.D. The economic impact of geriatric hip fractures // Am. J. Orthop. (Belle Mead NJ). 1999. Vol. 28, No 7. P. 423428.
  • Incidence and economic burden of osteoporosis-related fractures in the United States, 2005-2025 / R. Burge, B. Dawson-Hughes, D.H. Solomon, J.B. Wong, A. King, A. Tosteson // J. Bone Miner. Res. 2007. Vol. 22, No 3. P. 465-475. DOI: 10.1359/jbmr.061113.
  • A predictive model for increased hospital length of stay following geriatric hip fracture / O.M. Knoll, N. Lakomkin, M.S. Shen, M. Adebayo, P. Kothari, A.C. Dodd, B. Attum, N. Lee, D. Chona, M.K. Sethi // J. Clin. Orthop. Trauma. 2019. Vol. 10, No Suppl. 1. P. S84-S87. DOI: 10.1016/j. jcot.2019.03.024.
  • Handong L., Hongngoc N., Tianmin Z. Vietnam's Population Projections and Aging Trends from 2010 to 2049 // J. Population Ageing. 2021. Vol. 14, No 6. P. 165-182. DOI: 10.1007/s12062-019-09257-3.
  • WHO. Haemoglobin Concentrations for the Diagnosis of Anaemia and Assessment of Severity // World Health Organization. Geneva, 2011. URL: https://apps.who.int/iris/handle/10665/85839.
  • American Diabetes Association. 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2020 // Diabetes Care. 2020. Vol. 43, No Suppl. 1. P. S14-S31. DOI: 10.2337/dc20-S002.
  • WHO Noncommunicable diseases: Hypertension // World Health Organization. Geneva, September 29, 2015.
  • Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies / WHO Expert Consultation // Lancet. 2004. Vol. 363, No 9403. P. 157-163. DOI: 10.1016/S0140-6736(03)15268-3.
  • Davidson's Principles and Practice of Medicine. 23d Ed. / Ralston S., Penman I., Strachan M., Hobson R., editors. Elsevier. 2018. 1440 p.
  • C Reactive Protein (CRP) / S.M. Nehring, A. Goyal, P. Bansal, B.C. Patel. Treasure Island, FL: StatPearls Publishing, 2020.
  • Lewiecki E.M. Osteoporosis: Clinical Evaluation // Endotext / K.R. Feingold, B. Anawalt, A. Boyce, G. Chrousos, W.W. de Herder, K. Dhatariya, K. Dungan, J.M. Hershman, J. Hofland, S. Kalra, G. Kaltsas, C. Koch, P. Kopp, M. Korbonits, C.S. Kovacs, W. Kuohung, B. Laferrere, M. Levy, E.A. McGee, R. McLachlan, J.E. Morley, M. New, J. Purnell, R. Sahay, F. Singer, M.A. Sperling, C.A. Stratakis, D.L. Trence, D.P. Wilson, editors. South Dartmouth (MA): MDText.com, Inc. 2000. URL: https://www.ncbi.nlm.nih.gov/books/NBK279049/
  • Delay in Hip Fracture Surgery: An Analysis of Patient-Specific and Hospital-Specific Risk Factors / D.J. Ryan, H. Yoshihara, D. Yoneoka, K.A. Egol, J.D. Zuckerman // J. Orthop. Trauma. 2015. Vol. 29, No 8. P. 343-348. DOI: 10.1097/BOT.0000000000000313.
  • Clinical characteristics and outcomes of patients presenting with hip fractures at a tertiary care hospital in Pakistan / A. Arshad, M.T. Ibrahim, H. Arshad, M.B. Hammad, S.A. Sheikh, A.H. Khan, L. Jafri, S. Nadeem // Arch. Osteoporos. 2021. Vol. 16, No 1. P. 25. DOI: 10.1007/s11657-021-00895-9.
  • Clinical outcomes and hospital length of stay in 2,756 elderly patients with hip fractures: a comparison of surgical and non-surgical management / S.T. Tan, W.P. Tan, J. Jaipaul, S.P. Chan, S.S. Sathappan // Singapore Med. J. 2017. Vol. 58, No 5. P. 253-257. DOI: 10.11622/smedj.2016045.
  • Taylor M., Hopman W., Yach J. Length of stay, wait time to surgery and 30-day mortality for patients with hip fractures after the opening of a dedicated orthopedic weekend trauma room // Can. J. Surg. 2016. Vol. 59, No 5. P. 337-341. DOI: 10.1503/cjs.017014.
  • Survival and functional outcome according to hip fracture type: a one-year prospective cohort study in elderly women with an intertrochanteric or femoral neck fracture / P. Haentjens, P. Autier, M. Barette, K. Venken, D. Vanderschueren, S. Boonen; Hip Fracture Study Group // Bone. 2007. Vol. 41, No 6. P. 958-964. DOI: 10.1016/j.bone.2007.08.026.
  • Tuan N.T., Tuong P.D., Popkin B.M. Body mass index (BMI) dynamics in Vietnam // Eur. J. Clin. Nutr. 2008. Vol. 62, No 1. P. 78-86. DOI: 10.1038/ sj.ejcn.1602675.
  • Gender specific age-related changes in bone density, muscle strength and functional performance in the elderly: a-10 year prospective population-based study / R.M. Daly, B.E. Rosengren, G. Alwis, H.G. Ahlborg, , I. Sernbo,. M.K. Karlsson // BMC Geriatr. 2013. Vol. 13. P. 71. DOI: 10.1186/14712318-13-71.
  • Injury Mechanisms of Hip Fractures in India / J. George, V. Sharma, K. Farooque, S. Mittal, V. Trikha, R. Malhotra // Hip Pelvis. 2021. Vol. 33, No 2. P. 62-70. DOI: 10.5371/hp.2021.33.2.62.
  • Relationship between body mass index and fracture risk is mediated by bone mineral density / M.Y. Chan, S.A. Frost, J.R. Center, J.A. Eisman, T.V. Nguyen // J. Bone Miner. Res. 2014. Vol. 29, No 11. P. 2327-2335. DOI: 10.1002/jbmr.2288.
  • Risk factors for hip fracture in European women: the MEDOS Study. Mediterranean Osteoporosis Study / O. Johnell, B. Gullberg, J.A. Kanis, E. Allander, L. Elffors, J. Dequeker, G. Dilsen, C. Gennari, V.A. Lopes, G. Lyritis, G. Mazzuoli, L. Miravet, M. Passeri, P.R. Cano, A. Rapado, C. Ribot // J. Bone Miner. Res. 1995. Vol. 10, No 11. P. 1802-1815. DOI: 10.1002/jbmr.5650101125.
  • Obesity is not protective against fracture in postmenopausal women: GLOW / J.E. Compston, N.B. Watts, R. Chapurlat, C. Cooper, S. Boonen, S. Greenspan, J. Pfeilschifter, S. Silverman, A. Dez-Perez, R. Lindsay, K.G. Saag, J.C. Netelenbos, S. Gehlbach, F.H. Hooven, J. Flahive, J.D. Adachi, M. Rossini, A.Z. LaCroix, C. Roux, P.N. Sambrook, E.S. Siris, Glow Investigators // Am. J. Med. 2011. Vol. 124, No 11. P. 1043-1050. DOI: 10.1016/j.amjmed.2011.06.013.
  • Associations between Hip Fracture Operation Waiting Time and Complications in Asian Geriatric Patients: A Taiwan Medical Center Study / C.Y. Shen, C.H. Hsiao, W. Tsai, W.H. Chang, T.H. Chen // Int. J. Environ. Res. Public Health. 2021. Vol. 18, No 6. P. 2848. DOI: 10.3390/ ijerph18062848.
  • No association between waiting time to surgery and mortality for healthier patients with hip fracture: a nationwide Swedish cohort of 59,675 patients / K. Greve, K. Modig, M. Talback, E. Bartha, M. Hedstrom // Acta Orthop. 2020. Vol. 91, No 4. P. 396-400. DOI: 10.1080/17453674.2020.1754645.
  • Lewis P.M., Waddell J.P. When is the ideal time to operate on a patient with a fracture of the hip? : a review of the available literature // Bone Joint J. 2016. Vol. 98-B, No 12. P. 1573-1581. DOI: 10.1302/0301-620X.98B12.BJJ-2016-0362.R2.
  • National Hospital Discharge Survey (NHDS). United States Department of Health and Human Services. National Center for Health Statistics, 1990. URL: https://doi.org/10.3886/ICPSR06222.v1.
  • Length of hospital stay after hip fracture and risk of early mortality after discharge in New York state: retrospective cohort study / L.E. Nikkel, S.L. Kates, M. Schreck, M. Maceroli, B. Mahmood, J.C. Elfar // BMJ. 2015. Vol. 351. P. h6246. DOI: 10.1136/bmj.h6246.
  • Lieurance R., Benjamin J.B., Rappaport W.D. Blood loss and transfusion in patients with isolated femur fractures // J. Orthop. Trauma. 1992. Vol. 6, No 2. P. 175-179. DOI: 10.1097/00005131-199206000-00007.
  • Perioperative risk factors in patients with a femoral neck fracture - influence of 25-hydroxyvitamin D and C-reactive protein on postoperative medical complications and 1-year mortality / J.K. Fakler, A. Grafe, J. Dinger, C. Josten, G. Aust // BMC Musculoskelet. Disord. 2016. Vol. 17. P. 51. DOI: 10.1186/s12891-016-0906-1.
  • Mortality and serum urea and electrolytes on admission for hip fracture patients / J.R. Lewis, S.K. Hassan, R.T. Wenn, C.G. Moran // Injury. 2006. Vol. 37, No 8. P. 698-704. DOI: 10.1016/j.injury.2006.04.121.
  • Routine blood tests as predictors of mortality in hip fracture patients / A.S. Laulund, J.B. Lauritzen, B.R. Duus, M. Mosfeldt, H.L. J0rgensen // Injury. 2012. Vol. 43, No 7. P. 1014-1020. DOI: 10.1016/j.injury.2011.12.008.
  • Serum Albumin Predicts Survival and Postoperative Course Following Surgery for Geriatric Hip Fracture / D.D. Bohl, M.R. Shen, C.P. Hannon, Y.A. Fillingham, B. Darrith, C.J. Della Valle // J. Bone Joint Surg. Am. 2017. Vol. 99, No 24. P. 2110-2118. DOI: 10.2106/JBJS.16.01620.
  • Incidence and clinical significance of abnormalities in potassium, sodium and calcium levels in elderly patients with hip fractures during the perioperative period / L.T. Shi, X.Y. Cao, R. Gu, J.X. Zhao, Y. Zhang // Ann. Ital. Chir. 2020. Vol. 91. P. 187-191.
  • Patient and system factors of time to surgery after hip fracture: a scoping review / K.J. Sheehan, B. Sobolev, Y.F. Villan Villan, P. Guy // BMJ Open. 2017. Vol. 7, No 8. P. e016939. DOI: 10.1136/bmjopen-2017-016939.
  • Factors affecting delay to surgery and length of stay for patients with hip fracture / W.M. Ricci, A. Brandt, C. McAndrew, M.J. Gardner // J. Orthop. Trauma. 2015. Vol. 29, No 3. P. e109-e114. DOI: 10.1097/BOT.0000000000000221.
  • Length of stay, mortality, morbidity and delay to surgery in hip fractures / K.A. Lefaivre, S.A. Macadam, D.J. Davidson, R. Gandhi, H. Chan, H.M. Broekhuyse // J. Bone Joint Surg. Br. 2009. Vol. 91, No 7. P. 922-927. DOI: 10.1302/0301-620X.91B7.22446.
  • The Determinants of Costs and Length of Stay for Hip Fracture Patients / A. Castelli, S. Daidone, R. Jacobs, P. Kasteridis, A.D. Street // PLoS One. 2015. Vol. 10, No 7. P. e0133545. DOI: 10.1371/journal.pone.0133545.
  • The independent patient factors that affect length of stay following hip fractures / T. Richards, A. Glendenning, D. Benson, S. Alexander, S. Thati // Ann. R. Coll. Surg. Engl. 2018. Vol. 100, No 7. P. 556-562. DOI: 10.1308/rcsann.2018.0068.
  • C-reactive protein, bone loss, fracture, and mortality in elderly women: a longitudinal study in the OPRA cohort / S. Berglundh, L. Malmgren, H. Luthman, F. McGuigan, K. Akesson // Osteoporos. Int. 2015. Vol. 26, No 2. P. 727-735. DOI: 10.1007/s00198-014-2951-7.
  • Inflammatory Markers and the Risk of Hip and Vertebral Fractures in Men: the Osteoporotic Fractures in Men (MrOS) / J.A. Cauley, K.E. Barbour, S.L. Harrison, Y.K. Cloonan, M.E. Danielson, K.E. Ensrud, H.A. Fink, E.S. Orwoll, R. Boudreau // J. Bone Miner. Res. 2016. Vol. 31, No 12. P. 2129-2138. DOI: 10.1002/jbmr.2905.
  • Neumaier M., Metak G., Scherer M.A. C-reactive protein as a parameter of surgical trauma: CRP response after different types of surgery in 349 hip fractures // Acta Orthop. 2006. Vol. 77, No 5. P. 788-790. DOI: 10.1080/17453670610013006.
  • Paul P., Issac R.T. Delay in time from fracture to surgery: A potential risk factor for in-hospital mortality in elderly patients with hip fractures // J. Orthop. 2018. Vol. 15, No 2. P. 375-378. DOI: 10.1016/j.jor.2018.03.001.
  • Association of delay of urgent or emergency surgery with mortality and use of health care resources: a propensity score-matched observational cohort study / D.I. McIsaac, K. Abdulla, H. Yang, S. Sundaresan, P. Doering, S.G. Vaswani, K. Thavorn, A.J. Forster // CMAJ. 2017. Vol. 189, No 27. P. E905-E912. DOI: 10.1503/cmaj.160576.
  • Parker M., Johansen A. Hip fracture // BMJ. 2006. Vol. 333, No 7557. P. 27-30. DOI: 10.1136/bmj.333.7557.27.
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