Morbidity and Mortality in Jeju Residents over 50-Years of Age with Hip Fracture with Mean 6-Year Follow-Up: A Prospective Cohort Study

This prospective cohort study was performed to estimate the morbidity and mortality with 790 patients over 50-yr of age that sustained a femoral neck or intertrochanteric fracture from 2002 to 2006, followed-up for a mean of 6 yr (range, 4 to 9 yr). Crude and annual standardized mortality ratios (SMRs) were calculated; and mortalities in the cohort and the age and sex matched general population were compared. The risk factors on mortality and activities pre- and post-injury were assessed. Accumulated mortality was 16.7% (132 patients) at 1 yr, 45.8% (337 patients) at 5 yr, and 60% (372 patients) at 8 yr. SMR at 5 yr post-injury was 1.3 times that of the general population. Multivariate analysis demonstrated that age (OR, 1.074; 95% CI, 1.050-1.097; P<0.001), woman (OR, 1.893; 95% CI, 1.207-2.968; P=0.005), and medical comorbidity (OR, 1.334; 95% CI, 1.167-1.524 P<0.001) were independently associated with mortality after hip fracture. Only 59 of the 150 patients (39.3%) who were able to ambulate normally outdoors at preinjury retained this ability at final follow-up. Patients with a hip fracture exhibits higher mortality at up to 5 yr than general population. Age and a preinjury comorbidity are associated with mortality.     

Effect of Opioids on All-cause Mortality and Sustained Opioid Use in Elderly Patients with Hip Fracture: a Korea Nationwide Cohort Study

BackgroundThe purpose of our study was to assess the use of opioids before and after hip fracture in elderly patients in order to determine the effect of opioid use on all-cause mortality, and to analyze how the history of opioid use before fracture increases the risk of sustained use following hip fracture using a Korea nationwide cohort.MethodsOur study identified hip fracture patients from the Korean National Health Insurance Service-Senior cohort. The index date was defined as 90-days after admission to the acute care hospital that fulfilled the eligibility criteria of elderly hip fracture. Patients were classified into past user, current user, and sustained user according to the use of opioid at each period based on the time of admission and index date. The opioids were classified into strong opioids and tramadol. A generalized estimating equation model with a Poisson distribution and logarithmic link function was performed to estimate the adjusted rate ratios (aRRs) and 95% confidence intervals (CIs) to assess the association between past use and sustained use. A multivariable-adjusted Cox proportional hazard model was used to investigate the effects of strong opioid and tramadol use on all-cause mortality.ResultsA total of 12,927 patients were included in our study. There were 7,384 (57.12%) opioid past-users, 11,467 (88.71%) opioid current-users, and 7,172 (55.48%) sustained users. In comparison of the death risk according to current use or the defined daily dose of the opioids or past opioid use, there were no significant differences in the adjusted hazard ratio for death in all groups, compared to the current non-users (P > 0.05). Among survivors 1 year after hip fracture, opioid past-use increased the risk of opioid sustained use by 1.52-fold (aRR; 95% CI, 1.45–1.8; P < 0.001).ConclusionCurrent use and past use of opioid did not increase all-cause mortality after hip fracture in elderly patients over 65 years of age. Past use of opioid before hip fracture increased risk of sustained use of opioid compared to the current opioid used without past use.     

Comparison of Mortality,Length of Hospital Stay and Transfusion between Hemiarthroplasty and Total Hip Arthroplasty in Octo- and Nonagenarian Patients with Femoral Neck Fracture: a Nationwide Study in Korea

BackgroundThe purpose of this study was to compare the mortality rate between patients undergoing hemiarthroplasty (HA) and those undergoing total hip arthroplasty (THA) in two age groups: patients aged 65–79 years (non-octogenerian) and patients aged ≥ 80 years (octogenarian).MethodsWe identified elderly (aged ≥ 65 years) femoral neck fracture patients who underwent primary THA or HA from January 1, 2005 to December 31, 2015 in South Korea using the Health Insurance and Review and Assessment database; the nationwide medical claim system of South Korea. We separately compared the mortality rate between the HA group and THA group in two age groups. A generalized estimating equation model with Poisson distribution and logarithmic link function was used to calculate the adjusted risk ratio (aRR) of death according to the type of surgery.ResultsThe 3,015 HA patients and 213 THA patients in younger elderly group, and 2,989 HA patients and 96 THA patients in older elderly group were included. In the younger elderly group, the mortality rates were similar between the two groups. In older elderly group, the aRR of death in the THA group compared to the HA group was 2.16 (95% confidence interval [CI], 1.20–3.87; P = 0.010) within the in-hospital period, 3.57 (95% CI, 2.00–6.40; P < 0.001) within 30-days, and 1.96 (95% CI, 1.21–3.18; P = 0.006) within 60-days.ConclusionsIn patients older than 80 years, THA was associated with higher postoperative mortality compared to HA. We recommend the use of HA rather than THA in these patients.     

Improvement of Dementia Screening Accuracy of Mini-Mental State Examination by Education-Adjustment and Supplementation of Frontal Assessment Battery Performance

This study aimed to investigate whether the demographic variable-adjustment and supplementation of Frontal Assessment Battery (FAB) score can improve the screening ability of Mini-Mental State Examination (MMSE) for dementia and its subtypes. Five hundred forty-one non-demented comparison (NC) and 474 dementia (320 Alzheimer''s disease [AD]; 139 non-Alzheimer''s disease dementia [NAD]; and 15 mixed AD-NAD dementia) individuals living in the community were included. Education-adjusted MMSE (MMSE-edu) score showed significantly better screening accuracy for overall dementia, AD, and NAD than MMSE raw score. FAB-supplemented MMSE (MMSE-FAB) score had significantly better screening ability for NAD, but not for overall dementia and AD, than MMSE raw score alone. Additional supplementation of FAB to MMSE-edu further increased the ability for overall dementia or NAD screening, but not for AD screening. Further education adjustment of MMSE-FAB also improved its ability for overall dementia, AD, and NAD screening. These results strongly support the usefulness of education-adjustment and supplementation of frontal function assessment to improve screening performance of MMSE for dementia and its subtypes, NAD in particular.     

老年髋部骨折术后功能恢复的影响因素研究

髋部骨折是老年人最常见的骨折类型,其发病率随着年龄的增长而增加,严重影响老年人日常生活和活动。目前,老年人髋部骨折的治疗方法仍然以手术治疗结合功能锻炼为主,手术治疗具有并发症少、死亡率低、恢复快等特点,但老年髋部骨折患者术后4~12个月髋关节功能不能完全恢复到骨折前水平,将对患者的日常生活质量造成影响。因此,充分了解影响老年髋部骨折患者术后功能恢复的相关因素,对改善老年髋部骨折患者的预后具有重要的临床意义。本文从年龄、性别、伤前基础病、骨折前巴塞尔（Barthel）指数、骨折类型、手术时机、手术方式、ASA分级、麻醉方式、术后并发症等方面对老年人髋部骨折术后功能恢复的影响作一综述,旨在为促进术后功能恢复提供参考。     

Poor Prognosis in Elderly Patients Who Refused Surgery Because of Economic Burden and Medical Problem After Hip Fracture

Although many studies have assessed mortality and morbidity of conservative treatment after hip fracture in elderly patients, the mortality of conservative treatment done because of economic burden is unclear. Among 451 patients diagnosed with displaced hip fracture during 3 yr, 28 patients (Group I) were enrolled as conservative treatment. Fifty-six patients matched in age, gender, ASA score, and diagnosis (Group II) who had undergone surgical treatment were used as the control group. The causal factors of non-operative treatment and mortality rate and functional recovery were evaluated according to the causal factors of patients with surgical procedure. Ten patients (36%) in Group I involved medical problems and 18 (64%) by economic burdens. The cumulative mortality rate over 3, 6, 12, and 24 months was 54%, 61%, 64%, and 82% in Group I and 9%, 11%, 14%, and 21% in Group II, respectively. At the latest follow-up, all five patients in Group I displayed a nonfunctional ambulatory state, whereas only seven of 44 patients in Group II were in a nonfunctional ambulatory state. Non-surgical treatment following hip fracture that is done because of the economic burden is associated with substantially high mortality and serious functional loss.     

系统化康复护理在老年髋部骨折患者围手术期中的应用

目的 研究系统化康复护理对老年髋部骨折手术患者的影响。方法 选取2016年7月~2018年6月我院收治的老年髋部骨折患者125例,随机分为观察组（63例）和对照组（62例）。对照组给予常规护理,观察组在常规护理基础上给予系统化康复护理,比较两组护理前、术后1个月、术后3个月Harris髋关节功能评分和Barthel 指数评分,住院费用、住院时间及术后并发症发生率。结果 两组护理后Harris髋关节功能评分、Barthel 指数评分、住院时间及住院费用、术后并发症发生率比较,差异均有统计学意义（P＜0.05）。结论 系统化康复护理能有效改善老年髋部骨折手术患者的关节活动功能,缩短住院时间,减少住院费用,提高生活质量及生活自理能力。     

Effect of a Patient Blood Management Program on the Appropriateness of Red Blood Cell Transfusion and Clinical Outcomes in Elderly Patients Undergoing Hip Fracture Surgery

BackgroundElderly patients with hip fractures frequently receive perioperative transfusions, which are associated with increased morbidity and mortality. This study aimed to evaluate the impact of a patient blood management (PBM) program on the appropriateness of red blood cell (RBC) transfusion and clinical outcomes in geriatric patients undergoing hip fracture surgery.MethodsIn 2018, the revised PBM program was implemented at the Korea University Anam Hospital, Seoul, Republic of Korea. Elderly patients aged ≥ 65 years who underwent hip fracture surgery from 2017 to 2020 were evaluated. Clinical characteristics and outcomes were analyzed according to the timing of PBM implementation (pre-PBM, early-PBM, and late-PBM). Multiveriate regression analysis was used to evaluate the risk factors of the adverse outcomes, such as in-hospital mortality or 30-day readmission.ResultsA total of 884 elderly patients were included in this study. The proportion of patients who received perioperative RBC transfusions decreased significantly (43.5%, 40.1%, and 33.2% for pre-PBM, early-PBM, and late-PBM, respectively; P = 0.013). However, the appropriateness of RBC transfusion significantly increased (54.0%, 60.1%, and 94.7%, respectively; P < 0.001). The duration of in-hospital stay and 30-day readmission rates significantly decreased. Multivariable regression analysis revealed that RBC transfusion (odds ratio, 1.815; 95% confidence interval, 1.137–2.899; P = 0.013) was significantly associated with adverse outcomes.ConclusionImplementing the PBM program increased the appropriateness of RBC transfusion without compromising transfusion quality and clinical outcomes. Therefore, adopting the PBM program may improve the clinical management of elderly patients following hip fracture surgery.     

Trend in Hip Fracture Incidence and Mortality in Korea: A Prospective Cohort Study from 2002 to 2011

This prospective longitudinal cohort study was to assess the 10-yr hip fracture incidence and mortality trend of person ≥50 yr of age between 2002 and 2011 of eight hospitals in Jeju Island. Sex-specific incidence rate (per 100,000 person-years) were calculated based on that estimated for the population in the United States in 2008. Poisson and logistic regressions were used to examine trends in incidence and mortality. There was a 101% increase in the number of hip fractures from 151 in 2002 to 304 in 2011. The crude incidence of hip fractures in the Jeju population ≥50 yr of age increased from 126.6/100,000 to 183.7/100,000. The fracture incidence in the population standardized to the 2008 population in the United States increased from 100.6/100,000 for men and 194.4/100,000 for women in 2002 to 114.2/100,000 for men and 278.4/100,000 for women in 2011. The annual increasing incidence rate of hip fracture was 4.3% (5.3% in women and 2.2% in men). Poisson regression did not show significant trends in the mortality rates for all age groups or for both genders. The total number of hip fractures increased two-fold and the incidence rate of hip fractures increased markedly during the 10-yr study period.

Graphical Abstract

相似文献   

High Prevalence of Sarcopenia in Korean Patients after Hip Fracture: a Case-Control Study

Sarcopenia-related falls and fractures are increasing worldwide due to the aging population. The purpose of this study was to 1) evaluate anthropometric characteristics related to hip fracture in Korean patients, 2) investigate sarcopenia prevalence in hip fracture (HF) and non-hip fracture (NF) groups, and 3) investigate the correlation between sarcopenia and osteoporosis. This case-control study examined 359 HF and 1,614 NF normal populations using Korea National Health and Nutrition Examination Survey data. We performed whole-body dual energy X-ray absorptiometry to analyze body composition using the skeletal muscle mass index (SMI: lean mass/height²) and bone mineral density (BMD). In the HF group, using the AWGS definition, the prevalence of sarcopenia in women and men was 44.3% and 68.2%, respectively; in the NF group, it was 7.1% and 16.1%, respectively. Lower appendicular SMI (P < 0.001), leg muscle mass (P < 0.001), and higher prevalence of sarcopenia (P < 0.001) were observed in the HF group after adjustment for age and gender. In multivariate analysis, sarcopenia (OR = 6.52; 95% CI = 4.67-9.09), age (OR = 1.15; 95% CI = 1.13-1.17), and osteoporosis (OR = 1.87; 95% CI = 1.35-2.58) were associated with the occurrence of a hip fracture. This study showed a higher prevalence of sarcopenia in patients with hip fractures compared with a normal population, and higher prevalence of sarcopenia in men.     

髋部肌肉密度下降对老年股骨近端骨折的影响研究

目的 观察髋部肌肉密度下降对老年股骨近端骨折的影响。方法 选择2016年5月15日~2017年5月15日我院收治的老年股骨近端骨折患者50例设置为实验组,另收集50例健康体检人群设为常规组,分析两组前群肌肉、后群肌肉、内侧群肌肉的CT检测值。结果 实验组髋部健侧与患侧的前群、后群、内侧群肌肉的CT检测值比较,差异均无统计学意义（P＞0.05）;常规组的前群肌肉、后群肌肉CT值分别为（44.23±5.36）Hu与（39.23±5.36）Hu,实验组的前群肌肉、后群肌肉CT值分别为（35.66±4.15）Hu与（22.36±5.47）Hu,组间比较,差异有统计学意义（P＜0.05）;两组受检者的内侧群肌肉CT值比较,差异无统计学意义（P＞0.05）。结论 髋部肌肉密度降低,不会对股骨近端骨折患侧髋部肌肉的密度造成明显的影响,但可能会增加患者发生股骨近端骨折的风险。     

Effect of Opioids on All-cause Mortality and Opioid Addiction in Total Hip Arthroplasty: a Korea Nationwide Cohort Study

BackgroundThe purpose of this study was to investigate the use of opioids before and after total hip arthroplasty (THA), to find out the effect of opioid use on mortality in patients with THA, and to analyze whether preoperative opioid use is a risk factor for sustained opioid use after surgery using Korean nationwide cohort data.MethodsThis retrospective nationwide study identified subjects from the Korean National Health Insurance Service-Sample cohort (NHIS-Sample) compiled by the Korean NHIS. The index date (time zero) was defined as 90 days after an admission to a hospital to fulfill the eligibility criteria of the THA.ResultsIn the comparison of death risk according to current use and the defined daily dose of tramadol and strong opioids in each patient group according to past opioid use, there were no statistically significant differences in the adjusted hazard ratio for death compared to the current non-users in all groups (P > 0.05). Past tramadol and strong opioid use in current users increased the risk of the sustained use of tramadol and strong opioids 1.45-fold (adjusted rate ratio [aRR]; 95% confidence interval [CI], 1.12–1.87; P = 0.004) and 1.65-fold (aRR; 95% CI, 1.43–1.91; P < 0.001), respectively, compared to past non-users.ConclusionIn THA patients, the use of opioids within 6 months before surgery and within 3 months after surgery does not affect postoperative mortality, but a past-use history of opioid is a risk factor for sustained opioid use. Even after THA, the use of strong opioids is observed to increase compared to before surgery.     

聚焦解决模式对老年股骨隆间骨折患者术后康复的影响

目的 探讨基于聚焦解决模式的心理干预联合渐进式功能锻炼对老年股骨粗隆间骨折术后患者负性情绪及生活质量的影响。方法 采用随机数字表法将134例老年股骨粗隆间骨折患者分为对照组和观察组,各67例。对照组术后给予渐进式功能锻炼,观察组在对照组的基础上给予基于聚焦解决模式的心理干预联合渐进式功能锻炼。比较两组术后6个月内功能锻炼的依从性、术前（干预前）、术后6个月（干预后）Harris髋关节评分、术前、术后3 d、1个月、3个月、6个月抑郁自评量表（SDS）和焦虑自评量表（SAS）评分及术后6个月生活质量综合评定问卷（GQOLI-74）评分。结果 观察组功能锻炼的时间依从性、次数依从性均高于对照组（P＜0.05）;两组术后6个月Harris评分均较术前升高（P＜0.05）,且观察组高于对照组（P＜0.05）;观察组术后3 d、1个月、3个月、6个月时SAS和SDS评分均低于对照组（P＜0.05）;观察组躯体职能、心理职能、情绪职能、认知职能和社会职能均高于对照组（P＜0.05）。结论 基于聚焦解决模式的心理干预联合渐进式功能锻炼可增加患者康复的信心,缓解患者的负性心理,提高患者康复锻炼依从性,加速术后康复,提高生活质量,值得临床借鉴应用。     

32例老年人工全髋关节置换术的护理配合

目的探讨老年人工全髋关节置换术的护理及配合。方法对32例全髋关节置换患者,做好围手术期的各项护理措施。结果32例患者均顺利通过手术,术中无1例发生并发症。结论手术室护士周密的术前准备、熟练地术中配合、细心的术中观察、正确的术后搬运患者是手术成功的关键。     

Identification and Treatment of Osteoporosis among Elderly Patients with Hip Fractures

OBJECTIVE:

To evaluate the profile of osteoporosis treatment among patients hospitalized due to hip fractures at a tertiary-level university hospital. To compare the impact of hospitalization on approaches toward treating bone mass losses.

METHOD:

The medical records of 123 hip fracture patients aged 60 years and over at the Institute of Orthopedics, Hospital das Clínicas, University of São Paulo School of Medicine, between 2004 and 2006 were reviewed and analyzed with respect to approaches towards investigating osteoporosis and treatments before and after fracture.

RESULTS:

The patients’ mean age was 78 ± 8.3 years, and the majority were women (71.54%). The patients had a mean of 2.72 comorbidities and used 3.26 medications on average. Among these patients, 12.3% reported a previous diagnosis of osteoporosis, and 5.83% were on medication for this. The mean waiting time for surgery was 6.3 ± 7.54 days, and seven patients (5.7%) died during the hospitalization. There were no investigations using bone densitometry, no changes in osteoporosis therapy between admission and discharge (p = 0.375), and no reports of referrals for the patient to have access to treatment.

CONCLUSIONS:

Investigations and treatments of osteoporosis and strategies for preventing new fractures were not implemented during the hospitalization of these elderly patients with hip fractures, even though this is the most feared complication of osteoporosis. These data need to be disseminated so that professionals dealing with elderly patients are attentive to the need for primary and secondary prevention of osteoporosis because of the impact of fractures on these patients’ quality of life, independence, morbidities, and mortality.     

老年髋部骨折术后下肢深静脉血栓形成的预防及护理干预效果分析

目的 探析老年髋部骨折术后下肢深静脉血栓形成的预防和护理措施。方法 将2015年1月~2017年1月我院接收的老年髋部骨折术后患者90例进行回顾性分析,给予预防与护理措施,分析措施实施后患者下肢深静脉血栓形成形成发生率、住院时间及生活质量改善的情况。结果 患者下肢深静脉血栓形成发生率、住院时间、生存质量显著优于预防及护理措施实施前,P<0.05表示有统计学意义。结论 将预防与护理干预措施应用在老年髋部骨折术后患者临床护理中可有效降低下肢深静脉血栓形成发生率,改善患者生活质量,促进患者尽快康复。     

Subchondral Insufficiency Fracture of the Femoral Head in Elderly People

We evaluated the clinical course of subchondral insufficiency fracture of the femoral head (SIFFH) and its characteristic findings with special regard to joint space narrowing (JSN). Thirty-one cases of SIFFH of mean age 68.9 yr initially underwent limited weight-bearing conservative treatment. During the follow-up period, the patients with intractable pain underwent total hip arthroplasty (THA). For radiographic evaluation, lateral center-edge angle, JSN and femoral head collapse (FHC) were documented, and the extent of FHC was classified as mild (<2 mm), moderate (2-4 mm), and severe (>4 mm). The progression or new development of FHC more than 2 mm was evaluated on sequential plain radiographs. The relationship between radiographic parameters and clinical outcomes were evaluated. THAs were performed in 15 cases (48.4%). There was no significant correlation between clinical outcomes and the extent of initial FHC. However, a significantly larger proportion of patients that underwent THA showed JSN and FHC progression compared to the symptom improvement group. The risk factor significantly associated with failed conservative treatment was JSN (P=0.038; OR, 11.8; 95% CI, 1.15-122.26). Clinical results of conservative treatment for SIFFH in elderly patients are relatively poor. The patients with JSN are at higher risk of failed conservative treatment.

Graphical Abstract

相似文献   

舒芬太尼联合右美托咪啶自控镇痛对股骨骨折老年病人术后的镇痛效果和谵妄的影响

目的:探讨舒芬太尼联合右美托咪啶自控镇痛在股骨骨折老年患者术后的镇痛效果,及其对谵妄的影响。方法:将256例行股骨手术的老年患者随机分为3组。对照组(86例)术后行舒芬太尼2μg/kg静脉自控镇痛(PCIA),实验1组(85例)术后行舒芬太尼2μg/kg联合右美托咪定2.5μg/kg PCIA,实验2组(85例)行舒芬太尼1.5μg/kg联合右美托咪定2.5μg/kg PCIA。观察并比较各组患者镇痛效果及谵妄的发生情况。结果:术后2h、8h、12h,实验1组、实验2组VAS评分显著低于对照组(实验1组t=10.03,7.74,4.84;实验2组t=11.98,8.44,5.47;P均0.05),而该时点实验1组、实验2组VAS评分比较均无统计学意义;与对照组比较,实验1组、实验2组术后舒芬太尼用量显著减少(t=15.99,26.77;P均0.05),有效按压次数、Ramsay镇静评分显著升高(t=5.21,7.61,24.77,26.08;P均0.05),而实验2组舒芬太尼用量较实验1组明显降低(t=10.75,P0.05);实验1组、实验2组术后3d内谵妄的总发生率显著低于对照组(χ2=5.52,4.40;P0.05);实验2组不良反应的发生率为10.6%,显著低于对照组24.4%、实验1组22.4%(χ2=5.65,4.27;P0.05)。结论:右美托咪啶联合舒芬太尼可增强老年股骨骨折患者术后PCIA的镇痛效果,减少药量与不良反应,降低术后谵妄的发生。     

Effects of mild and global cognitive impairment on the prevalence of fear of falling in community-dwelling older adults

Objectives

Few studies have reported the relationship between fear of falling (FoF) and mild and global cognitive impairment in community-dwelling older adults. We aimed to determine whether the status of cognitive impairment affects the prevalence of FoF in community-dwelling older adults.

Study design

Cross-sectional study among 4474 community-dwelling older adults who participated in the Obu Study of Health Promotion for the Elderly.

Main outcome measures

Participants underwent cognitive tests and were divided into three groups: cognitive healthy, mild cognitive impairment (MCI), and global cognitive impairment (GCI). FoF and related variables, such as fall history, physical function, and depression, were also investigated.

Results

The prevalence of FoF was significantly different by group (p < 0.001; healthy: 43.6%, MCI: 50.6%, GCI: 40.6%). Logistic regression analysis showed that GCI (odds ratio = 0.63; 95% confidence interval = 0.526–0.76) was independently associated with FoF, after controlling for confounding factors. Older adults with GCI showed the lowest prevalence of FoF, although they had the lowest physical function comparing with the other groups (p < 0.001).

Conclusion

MCI and GCI in community-dwelling older adults affect the prevalence of FoF in a completely different manner. Further study is required to determine whether insensitivity to FoF with GCI increases the risk of falling in older adults.