Short-Term Morbidity and Mortality after Distal Femur Open Reduction Internal Fixation in the Geriatric Population.

OBJECTIVE: Distal femur fractures remain a significant cause of morbidity and mortality for elderly patients. There is a lack of large population studies investigating short-term outcomes after distal femur c in elderly patients. The purpose of this study is to assess the incidence of and risk factors for various short-term outcomes after distal femur open reduction internal fixation (ORIF) in the geriatric population. METHODS: The American College of Surgeons' National Surgical Quality Improvement Program (NSQIP) database was used to identify all primary distal femur ORIF cases in patients 60+ years old between January 1, 2015 and December 31, 2020 using Current Procedural Terminology (CPT) codes 27511, 27513, and 27514. Demographic, medical, and surgical variables were extracted for all patients. Propensity score matching was used to match cases in the two age groups based on various demographic and medical comorbidity variables. Several 30-day outcome measures were compared between the 60-79-year-old and 80+-year-old groups both before and after matching. Subsequent multivariate logistic regression was used to identify independent risk factors for 30-day outcome measures in the matched cohort. RESULTS: A total of 2913 patients were included in the final cohort: 1711 patients in the 60-79-year-old group and 1202 patients in the 80+-year-old group. Most patients were female (n = 2385; 81.9%). Prior to matching, the older group had a higher incidence of 30-day mortality (1.9% vs. 6.2%), readmission (3.7% vs. 9.7%, p = 0.024), and non-home discharge (74.3% vs. 89.5%, p < 0.001). Additionally, the older group had a higher rate of blood loss requiring transfusion (30.9% vs. 42.3%, p < 0.001) and medical complications (10.4% vs. 16.4%, p < 0.001), including myocardial infarction (0.7% vs. 2.7%, p < 0.001), pneumonia (2.7% vs. 4.6%, p = 0.008), and urinary tract infection (4.1% vs. 6.1%, p = 0.0188). After matching, the older group consistently had a higher incidence of mortality, non-home-discharge, blood loss requiring transfusion, and myocardial infarction. Various independent risk factors were identified for 30-day morbidity and mortality, including American Society of Anesthesiologists (ASA) classification, body mass index (BMI) status, operative duration, and certain medical comorbidities. CONCLUSION: Geriatric patients undergoing distal femur ORIF are at significant risk for 30-day morbidity and mortality. After matching, octogenarians and older patients specifically are at increased risk for mortality, non-home discharge, and surgical complications compared to patients aged 60-79 years old. Multiple factors, such as BMI status, ASA classification, operative time, and certain medical comorbidities, are independently associated with poor 30-day outcomes.

A bibliometric analysis of cancer research funders and collaborators in Kenya: 2007-2017.

AIM: Cancer research is essential to the development and implementation of effective control strategies and interventions. In Kenya, cancer is the third leading cause of death. Country specific research conducted by local and international investigators can inform a national plan to address local needs across the cancer care continuum. This analysis aims to provide information about the trends and types of cancer research collaborations, funding, and outputs from 2007 to 2017, to understand gaps and opportunities to strengthen Kenya-led cancer research capacity. METHODS: This analysis included 243 studies from a previously published phase 1 scoping review of oncology research conducted and published in Kenya from 2007 to 2017. The citation metadata was drawn from the Web of Science and PubMed and normalized in Microsoft Excel. Using Sci2, a series of bibliometric network analyses were conducted to identify funding patterns, collaborations between authors and institutions, and the types of cancer research conducted in Kenya. Gephi and Excel provided descriptive analyses and graphs of the network. The analyses are categorized into three themes: article production, collaboration, and research topics. RESULTS: The bibliometric analysis found 5 US-based government agencies are funding cancer research in Kenya. Kenya-Kenya institutional collaborations were most common, and half of authors with the most co-authored publications were from Kenya. The publication trend showed a gradual increase from 2011 to 2014 with a subsequent drop through 2017. CONCLUSION AND POLICY SUMMARY STATEMENT: This study identifies the funders and most often published Kenyan authors and Kenyan-based institutions publishing oncology research in Kenya. It also identifies future areas to focus research and the importance of continuing to build the writing and publishing capacity on oncology research by Kenyans.