Evaluation of the incidence of pulmonary embolus in the early postoperative period following cemented hemiarthroplasty.

PURPOSE: Little is known regarding the incidence of early postoperative pulmonary embolus (PE) following hip fracture surgery. Clinical suspicion of PE mandates therapeutic anticoagulation, adding a further insult to those of trauma and surgery in a physiologically frail population. The aim of the study was to evaluate for the presence of PEs by performing postoperative CT pulmonary angiography (CTPA) in patients who demonstrated intraoperative, or early postoperative cardiorespiratory lability following surgery with a cemented prosthesis for intracapsular hip fracture. METHODS: All patients undergoing cemented hemiarthroplasty for displaced intracapsular neck of femur fracture were recruited during a 6-month period, and signed consent obtained from the patient or their next of kin for CTPA in the event of any cardiorespiratory instability. Patient demographics, comorbidities were reviewed, and premorbid mobility status documented. RESULTS: 18 of the 66 patients in the study having cemented hemiarthropalsty demonstrated intra- or early postoperative lability, all had early postoperative CTPA scans. 6 of the 18 were noted to have PE. All had more than 1 risk factor for VTE on admission (excluding their injury). Patients diagnosed with PE had a higher ASA grade, and lower mobility scores than those who did not have a PE. CONCLUSIONS: Clinical suspicion alone is inadequate to diagnosis PE in patients undergoing cemented hip arthroplasty. Only 1 in 3 patients suspected of PE on account of intraoperative or immediate postoperative cardiorespiratory lability was found to have a PE based on CTPA. Early postoperative CTPA is helpful to prevent unnecessary anticoagulation for suspected PE.

Serum albumin and total lymphocyte count as predictors of outcome in hip fractures.

BACKGROUND & AIMS: Hip fractures are a significant cause of mortality and morbidity in the elderly. Malnutrition is a significant contributor to this, however no consensus exists as to the detection or management of this condition. We hypothesise that results of admission serum albumin and total lymphocyte count (TLC), as markers of Protein Energy Malnutrition (PEM) can help predict clinical outcome in hip fracture patients aged over 60 years. METHODS: This retrospective study evaluated the nutritional status of patients with hip fractures using albumin and TLC assays and analysed their prognostic relevance. Clinical outcome parameters studied were delay to operation, duration of in-patient stay, re-admission and in-patient, 3- and 12-month mortality. RESULTS: Four hundred and fifteen hip fracture patients were evaluated. Survival data were available for 377 patients at 12 months. In-hospital mortality for PEM patients was 9.8%, compared with 0% for patients without. Patients with PEM had a higher 12-month mortality compared to patients who had normal values of both laboratory parameters (Odds Ratio 4.6; 95% CI: 1.0-21.3). Serum albumin (Hazard Ratio 0.932, 95% CI: 0.9-1.0) and age (Hazard Ratio 1.04, 95% CI: 1.0-1.1) were found to be significant independent prognostic factors of mortality by Cox regression analysis. CONCLUSIONS: These results highlight the relevance of assessing the nutritional status of patients with hip fractures at the time of admission and emphasises the correlation between PEM and outcome in these patients.

Long-term functional outcome in pyogenic spinal infection.

STUDY DESIGN: Retrospective. OBJECTIVE: To assess long-term adverse functional outcome following pyogenic spinal infection using standardized outcome measures, Oswestry disability index (ODI), and medical outcomes study short form-36 (SF-36). SUMMARY OF BACKGROUND DATA: There is minimal published data regarding the long-term functional outcome in pyogenic spinal infection. Previous studies have used heterogeneous, unreliable, and nonvalidated measure instruments yielding data that is difficult to interpret. METHODS: All cases of pyogenic spinal infection presenting to a single institution managed operatively and nonoperatively from 1994 to 2004 were retrospectively identified. Follow-up was by clinical review and standardized questionnaires. Inclusion in each case was on the basis of consistent clinical, imaging, and microbiology criteria. RESULTS: Twenty-nine cases of pyogenic spinal infection were identified. Twenty-eight percent were managed operatively and 72% with antibiotic therapy alone. Nineteen patients (66%) had an adverse outcome at a median follow-up of 61 months, despite only 5 patients (17%) having persistent neurologic deficit. A significant difference in SF-36 physical function scores was observed between patients with adverse outcome and patients who recovered (P = 0.003). SF-36 scores of all patients, regardless of management or outcome, failed to reach those of a normative population. A strong correlation was observed between ODI and SF-36 physical function scores (rho = 0.61, P < 0.05). Seventeen percent (n = 5) of admissions resulted in acute sepsis-related death. Delay in diagnosis of spinal infection (P = 0.025) and neurologic impairment at diagnosis (P < 0.001) were significant predictors of neurologic deficit at follow-up. Previous spinal surgery was associated with adverse outcome in patients requiring readmission within 1 year of hospital discharge following first spinal infection (P = 0.018). No independent predictors of adverse outcome, persistent neurologic impairment, readmission within 1 year, or acute death were identified by logistical regression analysis. CONCLUSION: High rates of adverse outcome detected using SF-36 and ODI suggest under-reporting of poor outcome when American Spinal Injury Association score alone is used to qualify outcome.