Pressure sores in elderly patients. The epidemiology related to hip operations

The prevalence and onset of pressure sores was studied in 283 patients admitted to a general hospital with either fracture of the proximal femur or for elective hip surgery. Ninety patients developed pressure sores, of which 60 are reported in detail. Most were in women aged 70 or more who had been admitted with hip fractures. The majority of pressure sores started soon after admission, particularly on the day of operation, after which the numbers of new cases decreased. Half the patients had more than one pressure sore and the commonest sites were the sacrum, heels, and buttocks. The mortality in patients with pressure sores was 27% and their mean length of stay in hospital far exceeded that of other patients. The prevention of pressure sores in elderly patients requires more skill and attention than the nurse alone can offer; it demands the help of the whole orthopaedic team.     

预见性护理对晚期肿瘤老年卧床患者压疮发生率及Braden评分的影响

分析将预见性护理用于晚期肿瘤老年卧床患者对压疮发生率、Braden评分的影响。 方法 选取南通大学附属医院2021年-2022年收治的74例晚期肿瘤老年卧床患者为研究对象，根据患者的 入院先后顺序分为对照组和观察组，每组37例。对照组实施常规护理，观察组实施预见性护理，比较两组 压疮发生情况及Braden评分。结果 观察组压疮发生率为5.41%，低于对照组的18.92%，差异有统计学意义 （P ＜0.05）；观察组护理后知觉、营养、皮肤剪切力及摩擦力、潮湿度评分均高于对照组，差异有统计 学意义（P ＜0.05）。结论 将预见性护理用于晚期肿瘤老年卧床患者护理中可有效预防压疮风险，并提高 Braden评分。     

Risk factors for pressure ulcers among elderly hip fracture patients

The purpose of this study was to estimate the incidence of hospital-acquired pressure ulcers among elderly patients hospitalized for hip fracture surgery and to identify extrinsic factors that are associated with increased risk. We conducted a secondary analysis of data abstracted from medical records at 20 hospitals in Pennsylvania, Texas, New Jersey, and Virginia. Participants were patients aged 60 years and older admitted with hip fracture to the study hospitals between 1983 and 1993. The incidence of hospital-acquired pressure ulcers was 8.8% (95% confidence interval 8.2%-9.4%). After adjusting for confounding variables, longer wait before surgery, intensive care unit stay, longer surgical procedure, and general anesthesia were significantly associated with higher pressure ulcer risk. Extrinsic factors may be important markers for high pressure ulcer risk in hospitalized hip fracture patients. Although it is not possible to eliminate factors such as requiring an intensive care unit stay or having a long surgical procedure, it may be possible to develop interventions that minimize pressure ulcer risk in patients who experience these factors.     

老年髋部骨折行手术治疗患者住院日影响因素分析

目的探讨影响老年髋部骨折行手术治疗患者住院日的影响因素。方法自2010-02－2012-02,纳入采用人工全髋关节置换术或人工股骨头置换术治疗年龄≥70岁的髋部骨折共91例。分析的因素包括患者的性别、年龄、伤侧、骨折类型、受伤至人院时间、受伤至手术时间、入院至手术时间、手术方式、术前合并症、入院血清白蛋白含量、入院淋巴细胞计数、入院血红蛋白含量、入院白细胞计数。结果单因素分析显示入院至手术时间、入院血红蛋白及骨折类型对患者住院时间有明显影响,多因素分析显示入院至手术时间延长和入院血红蛋白减少均显著增加了患者住院日（P=0．002和P=0．01）。结论入院至手术时间延长以及贫血会增加髋部骨折行手术治疗患者的住院日。     

Prognostic value of cardiac troponins in elderly patients with hip fracture—a systematic review

Cardiac troponins can be elevated in cardiac ischemic conditions or other diseases such as pulmonary embolism or renal failure, where they may predict outcome. We hypothesized that cardiac troponins offer useful prognostic information regarding morbidity and mortality in elderly hip fracture patients undergoing surgical therapy. A literature review was conducted using PubMed and CINAHL plus with full text (EBSCOhost). Articles with original data relating troponins to prognosis in elderly hip fracture patients were reviewed. Studies with patients not undergoing surgery or undergoing elective or nonhip fracture surgery were excluded. Six papers met inclusion criteria. Troponin elevation was seen in 26.7–39 % of patients, while myocardial infarction, cardiac complications, and cardiac death occurred in ≤35 % troponin-positive patients in four of six studies. Several noncardiac factors were associated with elevated troponin including higher American Society of Anaesthesiologists score, current smoking, reduced mobility/activity level, lower hemoglobin, and living in residential care. Patients with elevated troponin had longer lengths of stay, increased risk for discharge to long-term care facilities, and higher mortality. Increased age, male sex, and higher American Society of Anaesthesiologists score were also associated with mortality. Elevated troponin can be used as a marker of increased morbidity/mortality in elderly hip fracture patients undergoing surgery, as hypothesized, even in the absence of cardiac complications. Perioperative troponin evaluation may be useful for risk stratification, but further studies are needed to clarify risks and benefits of such testing.     

高龄髋部骨折患者早期转入ICU的临床价值

目的探讨高龄髋部骨折患者早期转入ICU的临床价值。方法回顾性分析2017年5月-2019年4月收治的106例高龄髋部骨折患者临床资料,均给予手术治疗,术后即时转入ICU者为观察组(n=64),术后转回普通病房48 h内转入ICU者为对照组(n=42),统计比较两组术前、入ICU时急性生理与慢性健康(APACHEⅡ)评分、住院时间、医疗费用、病死率、并发症发生率。结果观察组APACHEⅡ评分低于对照组(P<0.05);住院时间短于对照组,医疗费用低于对照组(P<0.05);观察组感染发生率7.81%、深静脉血栓发生率3.13%、死亡率1.56%,低于对照组30.95%、16.67%、14.29%(P<0.05)。结论高龄髋部骨折患者早期转入ICU有助于缩短住院时间,减少医疗费用,降低并发症发生率及病死率,改善疾病预后。     

老年髋部骨折患者术后2年内再发对侧髋部骨折的危险因素研究

目的:探讨老年髋部骨折患者术后2年内再发对侧髋部骨折的相关危险因素。方法:回顾性分析2015年5月至2018年4月期间北京积水潭医院创伤骨科采用手术治疗的1 962例老年髋部骨折患者资料。男573例,女1 389例;首次骨折时的年龄中位数为81（75,86）岁。根据术后2年内是否发生对侧髋部骨折分为两组：对侧髋部骨折组...     

Factors affecting quality of care for elderly subjects undergoing surgery for hip fracture: review of the literature

Hip fractures are one of the leading causes for admission of elderly subjects to healthcare facilities. Because of population aging, the incidence of hip fractures has increased considerably over the last years and will continue to increase in industrialized countries. Hip fracture in an elderly subject may be life threatening and has a significant functional and social impact not only because of the fracture itself, but also because of the risk of complications related to the patient's health status and the long hospital stay. The purpose of this work was to identify in the published literature professional practices, excepting the surgical procedure, associated with better early and long-term outcome in elderly patients with hip fracture. Questions raised concerning the patient's hospital stay include factors related to the preoperative phase (time to surgery, usefulness of traction), the operation itself (antibiotic prophylaxis, anesthesia technique), and the postoperative phase (prevention of venous thrombosis, malnutrition, episodes of confusion, duration of indwelling bladder catheter, correction of anemia, geriatric care during the stay in the orthopedic ward, early and intense rehabilitation, prevention of recurrence). Among these factors, several appear to be associated with better outcome, including long-term outcome--surgery as early as possible in light of the patient's general status, antibiotic prophylaxis in accordance with standard recommendations (SFAR), prevention of venous thrombosis with low-molecular-weight heparin initiated at admission and associated with elastic contention. Oral nutritional support is probably beneficial and should be proposed for all patients. Particular attention must be given to prevention of confusion in order to reduce the rate of institutionalization. The rythm of rehabilitation exercises should be at least five sessions per week. Finally, there are several methods, which are effective in preventing recurrence, taking into account osteoporosis, risk of falls. Preventive measures should be instituted for all patients undergoing surgery for hip fracture.     

Pressure sores common after hip operations

We report the incidence of pressure sores in patients operated on for hip fracture or with total hip replacement. Pressure sores were found in 30 and 4 per cent, respectively. Half of the sores appeared within 1 week postoperatively, and more than half healed in the hospital. Most of the sores were found in patients over 80 years of age.

No relation was found between pressure sores and smoking, diabetes mellitus, low hemoglobin, and poor state of nutrition. Patients with pressure sores stayed in the hospital longer and were often discharged to nursing homes.     

Pressure sores common after hip operations

We report the incidence of pressure sores in patients operated on for hip fracture or with total hip replacement. Pressure sores were found in 30 and 4 per cent, respectively. Half of the sores appeared within 1 week postoperatively, and more than half healed in the hospital. Most of the sores were found in patients over 80 years of age.

No relation was found between pressure sores and smoking, diabetes mellitus, low hemoglobin, and poor state of nutrition. Patients with pressure sores stayed in the hospital longer and were often discharged to nursing homes.     

Pressure sores common after hip operations

We report the incidence of pressure sores in patients operated on for hip fracture or with total hip replacement. Pressure sores were found in 30 and 4 per cent, respectively. Half of the sores appeared within 1 week postoperatively, and more than half healed in the hospital. Most of the sores were found in patients over 80 years of age. No relation was found between pressure sores and smoking, diabetes mellitus, low hemoglobin, and poor state of nutrition. Patients with pressure sores stayed in the hospital longer and were often discharged to nursing homes.     

皮肤压疮预防护理在介入治疗术中的应用效果

目的 探究皮肤压疮预防护理在介入治疗术中的应用效果。 方法 选取2022年1月-2023年5月于我 院行介入治疗的168例患者为研究对象，按照护理方法不同分为常规组和干预组，每组84例。常规组行常 规护理，干预组在常规护理基础上行皮肤压疮预防护理干预，比较两组皮肤压疮风险程度、压疮发生情 况、压疮严重程度、护理质量及整体健康状况。 结果 干预组护理后Braden评分高于常规组，STT评分低于 常规组（P＜0.05）；干预组皮肤压疮总发生率为4.76%，低于常规组的19.05%（P＜0.05）；干预组皮肤压 疮严重程度低于常规组（P＜0.05）；干预组风险评估准确率、风险控制措施完成率、项目交接执行率均高 于常规组（P＜0.05）；干预组护理后HADS、VAS、PSQI评分均低于常规组（P＜0.05）。 结论 皮肤压疮 预防护理在介入治疗术中的应用效果确切，可在一定程度上降低皮肤压疮风险，减少皮肤压疮发生率，减 轻皮肤压疮严重程度，有利于提升护理质量，有效改善患者的整体健康状况。     

颅脑损伤后急性肾损伤的危险因素分析

目的 研究颅脑损伤后急性肾损伤(AKI)的发病情况及其危险因素.方法 采用前瞻性队列研究,收集我院2008年1月1日至2010年1月1日收治的颅脑损伤患者的临床资料.颅脑损伤诊断:明确的脑外伤病史,头颅CT证实,格拉斯哥昏迷(GCS)评分.AKI诊断标准:48 h内Scr上升≥26.4 μmol/L或较基础值增加≥50％ ;和(或)尿量＜0.5 ml·kg-1·h-1达6h.应用多因素回归方法筛选颅脑损伤患者发生AKI的危险因素.结果 791例患者颅脑损伤后AKI的发病率为39.4％,发生AK1的颅脑损伤患者住院病死率为27.9％,其死亡风险较非AKI患者增加5.065倍(P＜0.01).GCS评分≤8分(重型)者AKI的发病率为69.7％,显著高于中型和轻型两组(P＜0.01).多因素非条件Logistic回归分析显示,GCS评分低(≤8分)、低血压(收缩压＜90 mm Hg)、年龄(每增加10岁)、男性是颅脑损伤患者发生AKI的独立危险因素,OR值分别为2.932、2.176、1.789、1.544.结论 AKI是颅脑损伤患者常见的并发症.GCS评分低、低血压、高龄、男性是颅脑损伤患者发生AKI的独立危险因素.     

Multivariate analysis of factors associated with unplanned admission in 'outpatient' ophthalmic surgery

We performed a case-control study of patients undergoing planned "outpatient" ophthalmic surgery in order to identify risk factors associated with the need for unplanned admission to the hospital. factors associated with admission included time of completion of surgery, duration of operation, fentanyl dose, use of enflurane, and leukocytosis. A multiple logistic regression model found each of these variables except duration of operation to to be independently associated with unplanned admission with admission included age, present or past medical conditions, use of medications, blood pressure, hematocrit, serum sodium or potassium, and ASA Class. Identification and modification of these factors may help anticipate and/or reduced the incidence of unplanned admission to the hospital in patients undergoing planned outpatient surgery.     

Pressure sores in geriatric medicine: the role of nutrition

Malnutrition is frequent in geriatric patients: it affects 30 to 60% of elderly residents of institutions and 30 to 70% of patients admitted for short-term hospitalization. Malnutrition is a risk factor for developing pressure sores, and patients with them are more often and more severely malnourished than patients without them. In elderly subjects, multiple and interlinked factors may trigger or aggravate malnutrition; they may be physical, psychological or social and may be worsened by drugs and some diets. Malnutrition has been recognized as a risk factor for the onset and perpetuation of pressure sores. Of the dietary factors, protein intake seems most important. A low body mass index (BMI), low serum albumin, and weight loss are associated with an increased risk of pressure sores. A physician observing pressure sores must conduct a nutritional assessment, using clinical and laboratory screening tools. The criteria for malnutrition in elderly subjects are weight loss > or =5% in 3 months or > or =10% in 6 months, BMI<21 kg/m(2), serum albumin<35 g/L or a MNA (Mini Nutritional Assessment) score<17. Any one of these criteria is a sufficient basis for a diagnosis of malnutrition. Nutritional management is part of the prevention and treatment of pressure sores in geriatric medicine. It must be adapted for each patient. The recommended calorie intake in malnourished patients at risk of or with pressure sores is 30-40 kcal/kg/d, with 1.2-1.5 g of proteins/kg/d.     

Preoperative blood test results and type of fracture as transfusional risk factors in patients older than 65 years with trochanteric hip fracture

OBJECTIVE: To determine the effect of risk factors for allogenic blood transfusion in surgery for trochanteric hip fractures. PATIENTS AND METHODS: A retrospective study of all the trochanteric hip fracture patients older than 65 years who underwent surgery to repair trochanteric hip fracture related to osteoporosis in 2000 and 2001 in a regional hospital. Data recorded were age; gender; type of fracture (international AO classification); level of anesthetic risk (ASA classification); hemoglobin concentration and hematocrit upon admission, on the day of surgery and 2 days later; time elapsing between admission and surgery; blood transfusion and blood product use. RESULTS: One hundred two patients (29 men and 73 women) with trochanteric hip fractures were studied. Mean (+/- SD) patient age was 82.9 +/- 8.8 years (range, 65-99 years). Upon admission, mean hemoglobin was 123 +/- 18.1 g/L (range, 56-154 g/L), hematocrit was 37% +/- 5% (range, 10%-40%). Time elapsing until surgery was 3.5 +/- 1.6 days (range, 0-8 days). Admission hemoglobin concentration was lower in patients who required transfusion (116 g/L) than in patients who did not (133 g/L) (P < 0.001). Logistical regression analysis identified only AO classification of fracture type (P < 0.05) and admission hemoglobin concentration (P < 0.001) as independent risk factors for transfusion. CONCLUSIONS: The hemoglobin level at admission and the trochanteric fracture type bear a relation to transfusion needs. These results suggest that in elderly patients we should improve hemoglobin levels and initiate blood salvage measures in order to reduce the need for allogenic blood transfusion, with its inherent risks.     

老年股骨颈骨折后下肢深静脉血栓发生情况及其危险因素分析

目的:探究老年股骨颈骨折后下肢深静脉血栓的发生率、血栓位置及相关危险因素。方法:回顾性分析天津南开医院和河北医科大学第三医院2017年1月—2019年6月收治的老年股骨颈骨折患者708例。入院后,对患者行常规超声多普勒扫描以评估患者双下肢是否有深静脉血栓,将有血栓者为病例组(112例),无血栓者为对照组(596例)。提取患者的临床资料,包括人口学信息、合并病、受伤情况和入院时实验室结果,采用单因素检验和二元logistic回归分析确定DVT发生的相关危险因素。结果:共112例(15.8%)患者诊断为DVT,84例(75.0%)为远端型,21例(18.8%)为近端型,7例(6.2%)为混合型DVT。75.9%(85/112)的患者DVT发生在骨折侧肢体,12.5%(14/112)发生于双侧肢体,11.6%(13/112)发生于未骨折侧。多因素logistic回归分析显示,年龄大、D-二聚体升高(>0.5 mg/L、受伤至入院时间长、血清白蛋白水平降低(<35 g/L)和血小板计数(>262×10⁹/L)是发生下肢深静脉血栓的独立危险因素。结论:老年股骨颈骨折患者入院时DVT发生率较高,近端DVT达到6%。多个相关危险因素与DVT独立相关。     

Surgical Management of Solitary Metastatic Melanoma

Background: Pressure ulcers are a frequent complication of bed rest. The development of an efficient and low cost pressure relieving system for the prevention of bed-sores would be of considerable hospital health and economic interest. Our study was designed to determine the effectiveness in pressure-sore prevention of an interface pressure-decreasing mattress, the Kliniplot® mattress, used in our institution since 1978.

Methods: In a prospective randomised controlled 7-month clinical trial we compared the Kliniplot® mattress with our standard hospital mattress in 1729 patients admitted to medical and surgical departments (neurology, cardiology, oncology-haematology, neurosurgery, thoracic surgery and orthopaedic surgery). Two groups (Klinipot^® mattress and standard hospital mattress) were monitored for the prevention of pressure sores. The patients were evaluated on a daily basis from their admission until the eventual occurrence of a bed-sore. Patients’ characteristics and pressure-sore risk factors were similar at the baseline in both groups. Patients presenting with a pressure sore at the time of admission were excluded.

Results: Forty-two of the 1729 patients (2.4%) who entered the study developed at least one pressure sore. Twenty-one of the 657 patients (3.2%) nursed on the Kliniplot® mattress, and 21 of the 1072 patients (1.9%) on the standard mattress developed bed-sores (p = 0.154). The median time for the occurrence of pressure sores was 31 days (range 687) with the Kliniplot® mattress and 18 days (range 2 to 38) with the standard mattress (p < 0.001). The risk categories for developing bed-sores using the modified Ek’s scale were no different at the baseline between both groups (p = 0.764). The severity of the pressure sores was no different between both groups (p = 0.918).

Conclusions: Our results show that the occurrence of pressure sores is not reduced but is delayed when patients are nursed on a Kliniplot^® pressure-decreasing mattress.     

Delayed hospitalization increases mortality in displaced femoral neck fracture patients

Background and purpose Reports regarding the relationship between delayed surgery and mortality in femoral neck fracture patients are contradictory. We could not find any study in the literature investigating delayed arrival to hospital and delayed surgery as separate factors affecting mortality in femoral neck fracture patients, which was the purpose of our study.Patients and methods We analyzed 265 consecutive patients with displaced femoral neck fractures. We recorded the time period from trauma to admission, and to surgery, and correlated it to mortality during the first postoperative year.Results We found that arrival within 6 hours had 0.4 times (CI 0.2–0.8) reduction of the risk of death within 1 year compared to those who arrived later, whereas delayed surgery after admission did not have a statistically significant effect on mortality.Interpretation Femoral neck fracture patients who arrived at hospital 6 hours or later after the trauma had increased mortality.     

Association between pressure sores and immobilization in the immediate post-injury period

Pressure sores are a frequent complication of spinal cord injury (SCI) and are assumed to result from insufficient rotation following admission to the acute care unit. The likelihood of pressure sores occurring before admission to the nursing unit is not usually recognized. This study attempts to determine whether pressure sores are associated with prolonged immobilization in the early post-injury period, before admission to the acute care ward, and to identify other etiological factors relating to evacuation, transportation, and emergency room treatment. Thirty-two SCI patients were studied, 16 of whom developed sores in the hospital, and 16 who did not. Excluding five patients who failed to recall their immediate post-injury care, none of the remaining 14 patients with sores recalled being turned within two hours of injury; all 13 patients without sores said that they were rotated within two hours. Almost all patients said they were first turned on the hospital ward by a nurse. Whereas most of those without sores took less than two hours to reach the ward, most of those who later developed sores took three hours or longer.