Predictors of outcomes after internal fixation of periprosthetic femoral hip fractures Subgroup analysis of the peri-implant and peri-prosthetic fractures Spanish registry (PIPPAS).

PURPOSE: To identify risk factors predisposing patients to poor outcomes after fixation of periprosthetic hip fractures around femoral stems. METHODS: Prospective multicentre cohort study of fractures around a hip replacement stem managed by internal fixation. The primary outcome was one-year mortality, while secondary outcomes were local complications and healthcare burden-related outcomes (nursing facility utilization and hospital length of stay). RESULTS: One-year mortality was 16.2%. Age-adjusted Charlson Comorbidity Index score (OR=1.17; 95%CI=1.03-1.33)), Pfeiffer Short Portable Mental Status Questionnaire (SPMSQ) score (OR=1.16; 1.06-1.28), prosthetic dysfunction (OR=1.90; 1.00-3.61), and postoperative medical complications (OR=1.97; 1.06-3.68) were predictors of mortality. Patients with prior prosthetic dysfunction, lower Pfeiffer SPMSQ scores, Vancouver A fractures, and fractures fixed only using cerclages were at higher risk of local complications, which occurred in 9.3% of cases. Medical (OR=1.81; 1.05-3.13) and local complications (OR=5.56; 2.42-3.13) emerged as consistent risk factors for new institutionalization. Average hospitalization time was 13.9±9.2 days. Each day of fixation delay led to an average 1.4-day increase in total hospitalization. CONCLUSION: Frail periprosthetic hip-fracture patients with poorer functional status, dysfunctional replacements, and postoperative complications are at increased risk of mortality. Postoperative complications are more common in patients with dysfunctional arthroplasties, Vancouver A fractures, and fixation using cerclages alone. Postoperative complications were the most consistent predictor of higher healthcare resource utilization.

Clinical and Demographic Characteristics of Centenarians versus Other Age Groups Over 75 Years with Hip Fractures.

Objective: The primary objective was to describe the clinical characteristics, management, and outcomes of centenarians with fragility hip fracture and compare them to other age groups. The secondary objective was to determine the variables associated with length of stay, in-hospital mortality and 30-day mortality. Materials and Methods: This is a secondary analysis of the Spanish National Hip Fracture Registry. We included patients ≥75 years admitted for fragility hip fractures in 86 Spanish hospitals between 2017 and 2019, dividing the sample into four age groups. The variables studied were baseline characteristics, type of fracture, management, length of stay, in-hospital mortality and 30-day mortality. Results: We included 25,938 patients (2888 were 75-79 years old; 14,762 octogenarians; 8,035 nonagenarians and 253 centenarians). Of the centenarians, 83% were women, 33% had severe dementia, 9% had severe dependency and 36% lived in residential care homes. Six out of ten had intertrochanteric fracture. Length of hospital stay was 8.6 days; in-hospital mortality was 10.3% and 30-day mortality 20.9%. Older age groups had more women, severe functional dependency, severe dementia, intertrochanteric fracture, living in care facilities and being discharged to nursing care. They had less frequent early mobilization, osteoporosis treatment and discharge to rehabilitation units. In-hospital and 30-day mortality were higher with increasing age. In centenarians, time to surgery >48 hours was independently associated with length of stay (correlation coefficient 3.99 [95% CI: 2.35-5.64; p<0.001]) and anaesthetic risk, based on an ASA score of V, was related to 30-day mortality (ASA score II [OR 0.25, 95% CI: 0.09-0.70; p=0.009] and ASA score III [OR 0.43, 95% CI: 0.19-0.96; p=0.039]). Conclusion: Centenarians had different clinical characteristics, management and outcomes. Although centenarians had worse outcomes, nearly 4 out of 5 centenarians were alive one month after surgery.

Control de anemia y transfusión en el manejo perioperatorio de pacientes con fractura de cadera. Estudio de cohorte longitudinal / Control of anemia and transfusion in perioperative management of patients with hip fracture. A Cohort Study

Introducción El objetivo del estudio es pormenorizar los factores asociados a fracturas de cadera, prestando especial atención a las necesidades de transfusión de hemoderivados y sus factores de riesgo, así como su modificación a través del tratamiento preoperatorio mediante la administración de hierro intravenoso. Materiales y métodos Estudio observacional prospectivo de 119 pacientes ingresados por fractura de cadera. Descripción detallada del protocolo para la optimización prequirúgica de estos pacientes. Se recopilaron datos epidemiológicos, valores analíticos, así como datos acerca de la administración de hierro intravenoso y necesidad de transfusión. Resultados El 31,09% de los pacientes se encontraban antiagregados y el 21,85% estaban anticoagulados en el momento de la admisión. La hemoglobina media al ingreso fue de 12,5g/dl. El 43,2% se transfundieron durante la estancia hospitalaria. En el análisis de los factores de riesgo para la transfusión demostramos estadísticamente que tanto la hemoglobina al ingreso (p<0.001), como los diagnósticos previos de anemia crónica, hipertensión arterial e insuficiencia renal, tienen una relación con la necesidad de transfusión intrahospitalaria. Encontramos una relación estadísticamente significativa entre la administración de hierro y la cantidad de concentrados de hematíes trasfundidos (p<0.005). Los requerimientos de transfusión sanguínea fueron mayores en las fracturas extracapsulares que en las intracapsulares (p=0,024). Discusión Los pacientes con fractura de cadera presentan frecuentemente bajos niveles de hemoglobina al ingreso, así como comorbilidades y tratamientos que predisponen al desarrollo de anemia perioperatoria. La optimización preoperatoria de estos pacientes mediante la administración de hierro intravenoso podría reducir las necesidades transfusionales.

Background Aim of the study is to describe the elements associated with hip fractures about needs for transfusion of blood products and their risk factors, as well as their modification through preoperative treatment through the administration of intravenous iron. Material and methods A Cohort study of 119 patients admitted for hip fracture was conducted. Detailed description of the protocol for the pre-surgical optimization of these patients, epidemiological data, analytical values, as well as data on intravenous iron administration and need for transfusion were collected. Results 31.09% of the patients were using platelet aggregation inhibitors and 21.85% were were using anticoagulants at the time of admission. The mean hemoglobin on admission was 12.5g / dl. 43.2% were transfused during the hospital stay. In the analysis of risk factors for transfusion, we statistically demonstrated that both hemoglobin on admission (p <0.001), as well as previous diagnoses of chronic anemia, arterial hypertension, and renal failure, are related to the need for intra-hospital transfusion. We found a statistically significant relationship between iron administration and the amount of packed red blood cells transfused (p <0.005). Blood transfusion requirements were higher in extra-capsular than in intra-capsular fractures (p=0.024). Discussion Patients with hip fracture frequently present low hemoglobin levels upon admission, as well as comorbidities and treatments that predispose to the development of perioperative anemia. Preoperative optimization of these patients by administering intravenous iron could reduce transfusion requirements.