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1.
Arch Osteoporos ; 17(1): 6, 2021 12 22.
Artículo en Inglés | MEDLINE | ID: mdl-34939157

RESUMEN

For patients with hip fractures, outcomes can be measured by giving surveys measuring "patient rated outcome measures" (PROMs), performance based measures (PBMS), and objective medical outcomes (e.g., mortality, living situation, resource utilization). This study reviewed articles on hip fracture published in top academic journals, and found that most studies are not reliably using a single set of outcome measures including PROMs, and no single PROM or outcome battery is being used commonly. PURPOSE/INTRODUCTION: Osteoporotic hip fractures are associated with high levels of morbidity, mortality, and cost, while gains in mortality over the past 30 years have been modest. To improve care beyond simple mortality metrics requires identifying and then consistently measuring outcomes that are meaningful to patients and families. The purpose of this study was to review the top-tier hip fracture literature published in the past 30 years to determine if there are consensus outcome measures being routinely used and if the rate of reporting clinically meaningful patient-rated outcome measures is improving over time. METHODS: This was a systematic review and meta-analysis on outcome measures reported in osteoporotic hip fractures. Articles were included if they had been published over the last 30 years and were from high impact factor journals. Inclusion criteria were elderly hip fractures, therapeutic or prognostic study, unique and identifiable patients, and included follow-up beyond initial hospitalization. We analyzed study type, inclusion criteria, outcomes reported, and journal specialty orientation. RESULTS: Three hundred eighty-four articles were included in the final analysis. Sixty-seven percent of the articles were therapeutic studies; 33% were prognostic studies. The average number of patients in each study was 435; the average age was 78 years. The most commonly reported outcome was mortality, and was present in 79% of studies. There was a high degree of heterogeneity in patient-reported outcome measures, with the most popular score (Harris Hip Score) reported only 14% of the time. Only 6% of articles had all components of essential core outcome sets previously defined in the literature. CONCLUSIONS: Despite the apparent advances that have been made in our ability to care for hip fractures, the overall rate of reporting outcomes beyond mortality rate remains low. This lack of consensus represents a major barrier to implementation of value-based care in this patient population.


Asunto(s)
Fracturas de Cadera , Fracturas Osteoporóticas , Anciano , Fracturas de Cadera/terapia , Hospitalización , Humanos , Medición de Resultados Informados por el Paciente
2.
Arch Osteoporos ; 16(1): 167, 2021 11 06.
Artículo en Inglés | MEDLINE | ID: mdl-34741200

RESUMEN

Combining thematic analysis and a human-computer persuasive systems framework suggests that hip fracture recovery among older people can be enhanced through person-centered digital health hub models of care focused on behavior change education and integrated care. The findings intend to guide settings involving comorbid conditions and low- and middle-income countries in developing innovative digital health solutions. PURPOSE: The purpose of this study was to understand stakeholders' perspectives on the development of a digital health-enabled model of care for fragility hip fractures and to map out factors that could influence the design and implementation of such a model. METHODS: Qualitative in-depth interviews were conducted with stakeholders from various clinical disciplines, allied health, and computer science. A hybrid process involving thematic analysis of the raw data using inductive coding was the first step. In the second step, the tenets of a theoretical framework (health behavior change supporting systems) were deductively applied to the thematic constructs generated as part of the first step of the analysis. RESULTS: In total, 24 in-depth interviews were conducted with stakeholders. We identified 18 thematic constructs presented under the categories of context, content, and system. Context covered patient characteristics such as frailty, digital literacy, and patient or carer participation, whereas healthcare delivery aspects included the structure and culture of existing practice and the need for innovative holistic models of care. Content outlines the active ingredients and approach in developing a digital health hub, and it highlights the importance of targeted education and behavior change. The system is a complicated matrix crossing different aspects of healthcare and offering a value proposition design through personalization across modes of content delivery. This must foster trust, ensure adequate financing, and support ownership and privacy by establishing appropriate mechanisms for embedding change. CONCLUSION: The findings from this study provide insights around potential factors related to patients, community support, and healthcare delivery influencing the design and next-stage implementation of a digital health hub model of care for fragility hip fractures.


Asunto(s)
Fracturas de Cadera , Anciano , Atención a la Salud , Fracturas de Cadera/terapia , Humanos , Investigación Cualitativa , Australia del Sur
3.
JAMA Netw Open ; 4(11): e2134972, 2021 11 01.
Artículo en Inglés | MEDLINE | ID: mdl-34787657

RESUMEN

Importance: The COVID-19 pandemic has posed a number of unprecedented challenges to the health care system in France, where hip fractures in the elderly population are a major public health concern. Objective: To explore the association of the first nationwide COVID-19 lockdown in France with the absolute number of hip fractures among patients 50 years or older. Design, Setting, and Participants: This retrospective cohort study used data from the French national hospitals database to identify patients 50 years or older who were hospitalized for hip fracture in France from January to July 2019 and January to July 2020. Exposures: The first nationwide COVID-19 lockdown in France from March 16 to May 10, 2020. Main Outcomes and Measures: The main outcome was the number of hospitalizations for hip fracture from January to July 2020 (study period) compared with the number of hospitalizations for hip fracture during the same period in 2019 (control period). Hospitalization rate ratios (HRRs) comparing the study period with the control period were calculated for 3 intervals (before lockdown [January 1 to March 15], during lockdown [March 16 to May 10], and after lockdown [May 11 to July 31]) and were stratified by gender, age and hospital type. Results: The study included 46 393 patients hospitalized for hip fracture during January to July 2019 (34 589 [74.4%] women; mean [SD] age, 82.8 [10.5] years) and 44 767 patients hospitalized for hip fracture from January to July 2020 (33 160 [74.1%] women; mean [SD] age, 82.9 [10.5] years). During the lockdown in 2020, 10 429 patients (23.30%) were hospitalized for hip fracture compared with 11 782 patients (25.40%) during the same period in 2019 (HRR, 0.89; 95% CI, 0.86-0.91; P < .001). The lockdown period was associated with a decrease in the number of hip fractures of 11% among women (from 8756 in 2019 to 7788 in 2020) and 13% among men (from 3026 in 2019 to 2641 in 2020). When the absolute number of hip fractures was stratified by age group, the lockdown period was associated with a decrease in the number of hip fractures in all age groups except in patients older than 89 years (HRR, 0.97; 95% CI, 0.92-1.01; P = .17). In the group of patients aged 80 to 89 years, the number of hip fractures decreased from 4925 to 4370 (HRR, 0.89; 95% CI, 0.85-0.92; P < .001). During the lockdown, hospitalizations decreased by 33% (HRR, 0.67; 95% CI, 0.63-0.71; P < .001) in public university hospitals and by 24% (HRR, 0.76; 95% CI, 0.73-0.79; P < .001) in public general hospitals but increased by 46% (HRR, 1.46; 95% CI,1.38-1.54; P < .001) in private for-profit hospitals. Conclusions and Relevance: In this cohort study, hospitalizations for hip fractures in France decreased by 11% during the first nationwide COVID-19 lockdown. Further studies are needed to investigate the long-lasting consequences of the COVID-19 pandemic on the incidence of osteoporotic fractures.


Asunto(s)
COVID-19 , Control de Enfermedades Transmisibles , Fracturas de Cadera/epidemiología , Hospitalización , Fracturas Osteoporóticas/epidemiología , Pandemias , Anciano , Anciano de 80 o más Años , Femenino , Francia , Fracturas de Cadera/terapia , Hospitales , Humanos , Incidencia , Masculino , Fracturas Osteoporóticas/terapia , Estudios Retrospectivos , SARS-CoV-2
4.
J Med Internet Res ; 23(10): e26886, 2021 10 28.
Artículo en Inglés | MEDLINE | ID: mdl-34709183

RESUMEN

BACKGROUND: Most older people after a hip fracture injury never return to their prefracture status, and some are admitted to residential aged care facilities. Advancement of digital technology has helped in optimizing health care including self-management and telerehabilitation. OBJECTIVE: This study aims to understand the perspectives of older patients with hip fracture and their family members and residential aged caregivers on the feasibility of developing a model of care using a personalized digital health hub. METHODS: We conducted a mixed methods study in South Australia involving patients aged 50 years and older, their family members, and residential aged caregivers. Quantitative data analysis included basic demographic characteristics, and access to digital devices was analyzed using descriptive statistics. Spearman rank-order correlation was used to examine correlations between the perceived role of a personalized digital health hub in improving health and the likelihood of subsequent use. Findings from qualitative analysis were interpreted using constructs of capability, opportunity, and motivation to help understand the factors influencing the likelihood of potential personalized digital health hub use. RESULTS: This study recruited 100 participants-55 patients, 13 family members, and 32 residential aged caregivers. The mean age of the patients was 76.4 (SD 8.4, range 54-88) years, and 60% (33/55) of the patients were female. Approximately 50% (34/68) of the patients and their family members had access to digital devices, despite less than one-third using computers as part of their occupation. Approximately 72% (72/100) of the respondents thought that personalized digital health hub could improve health outcomes in patients. However, a moderate negative correlation existed with increasing age and likelihood of personalized digital health hub use (Spearman ρ=-0.50; P<.001), and the perceived role of the personalized digital health hub in improving health had a strong positive correlation with the likelihood of personalized digital health hub use by self (Spearman ρ=0.71; P<.001) and by society, including friends and family members (Spearman ρ=0.75; P<.001). Most patients (54/55, 98%) believed they had a family member, friend, or caregiver who would be able to help them use a personalized digital health hub. Qualitative analysis explored capability by understanding aspects of existing knowledge, including willingness to advance digital navigation skills. Access could be improved through supporting opportunities, and factors influencing intrinsic motivation were considered crucial for designing a personalized digital health hub-enabled model of care. CONCLUSIONS: This study emphasized the complex relationship between capabilities, motivation, and opportunities for patients, their family members, and formal caregivers as a patient networked unit. The next stage of research will continue to involve a cocreation approach followed by iterative processes and understand the factors influencing the development and successful integration of complex digital health care interventions in real-world scenarios.


Asunto(s)
Fracturas de Cadera , Telerrehabilitación , Anciano , Anciano de 80 o más Años , Cuidadores , Familia , Femenino , Fracturas de Cadera/terapia , Humanos , Persona de Mediana Edad , Motivación
5.
Arch Osteoporos ; 16(1): 152, 2021 10 08.
Artículo en Inglés | MEDLINE | ID: mdl-34625842

RESUMEN

PURPOSE: Even though hip fracture care pathways have evolved, mortality rates have not improved during the last 20 years. This finding together with the increased frailty of hip fracture patients turned hip fractures into a major public health concern. The corresponding development of an indicator labyrinth for hip fractures and the ongoing practice variance in Europe call for a list of benchmarking indicators that allow for quality improvement initiatives for the rapid recovery of fragile hip fractures (RR-FHF). The purpose of this study was to identify quality indicators that assess the quality of in-hospital care for rapid recovery of fragile hip fracture (RR-FHF). METHODS: A literature search and guideline selection was conducted to identify recommendations for RR-FHF. Recommendations were categorized as potential structure, process, and outcome QIs and subdivided in-hospital care treatment topics. A list of structure and process recommendations that belongs to care treatment topics relevant for RR-FHF was used to facilitate extraction of recommendations during a 2-day consensus meeting with experts (n = 15) in hip fracture care across Europe. Participants were instructed to select 5 key recommendations relevant for RR-FHF for each part of the in-hospital care pathway: pre-, intra-, and postoperative care. RESULTS: In total, 37 potential QIs for RR-FHF were selected based on a methodology using the combination of high levels of evidence and expert opinion. The set consists of 14 process, 13 structure, and 10 outcome indicators that cover the whole perioperative process of fragile hip fracture care. CONCLUSION: We suggest the QIs for RR-FHF to be practice tested and adapted to allow for intra-hospital longitudinal follow-up of the quality of care and for inter-hospital and cross-country benchmarking and quality improvement initiatives.


Asunto(s)
Fracturas de Cadera , Indicadores de Calidad de la Atención de Salud , Anciano , Benchmarking , Consenso , Fracturas de Cadera/epidemiología , Fracturas de Cadera/terapia , Humanos , Mejoramiento de la Calidad
6.
Int J Health Plann Manage ; 36(5): 1445-1464, 2021 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-34519092

RESUMEN

BACKGROUND: Studies have found that optimised care chain (OCC) can promote the recovery of hip fracture patients. Fast track (FT) has been widely proven to play a good role, but there is no systematic review report. METHODS: We conducted a comprehensive search and obtained search data as of April 2020. These included randomised controlled trials (RCTs) and cohort trials (CTs). We applied the research input Review Manager 5.3 for data synthesis, and used Stata 12.0 for meta- regression analysis. RESULTS: This review reported 2200 hip fractures. Our analysis showed that OCC can reduce complications and 1-year mortality, and shorten the length of stay (LOS). After dividing the complications into bed-related complications and other complications, OCC has advantages in reducing bed-related complications, but has no significant effect on other complications. For the conventional care group, the secondary outcome of the OCC group showed there was no significant difference in duration of surgery, and the rest were significantly improved. Subgroup analysis between green channel (GC) and FT showed a shorter LOS for GC. CONCLUSIONS: This meta-analysis suggests that the use of OCC in China promotes rehabilitation in elderly patients with hip fractures, that FT and GC are similar in effect in China, and that GC shows a greater advantage in reducing LOS.


Asunto(s)
Fracturas de Cadera , Anciano , China , Fracturas de Cadera/terapia , Humanos , Tiempo de Internación
7.
Ned Tijdschr Geneeskd ; 1652021 09 02.
Artículo en Holandés | MEDLINE | ID: mdl-34523843

RESUMEN

Integrated orthogeriatric treatment, led by a nurse practitioner, is an important step forward in the improvement of care for older people with a hip fracture. In this paper we reflect on the study of Van Leendert et al. Their main findings are similar to the literature with a significantly reduced 1-year mortality rate in the orthogeriatric group compared to the standard care group. However, there are some remarks to be made regarding the patient characteristics that are unbalanced in favor of the orthogeriatric group, with an overrepresentation of a certain type of fracture, indicating potentially more vulnerable patients in the standard care group. Although a significant step forward, we also address that still face major challenges, that technology might be an enabler for further improvement but that it might also be time to introduce a new perspective on recovery that makes better use of the dynamics of the system.


Asunto(s)
Servicios de Salud para Ancianos , Fracturas de Cadera , Anciano , Fracturas de Cadera/terapia , Humanos , Tiempo de Internación
8.
Orthop Clin North Am ; 52(4): 297-304, 2021 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-34538342

RESUMEN

The direct anterior approach (DAA) is gaining popularity in primary total hip arthroplasty (THA). Although DAA has demonstrated many advantages over other surgical approaches, periprosthetic femur fractures (PPFF) rates continue to be higher. Femoral stem designs that allow for easier insertion via a DAA may contribute to the higher rates of fracture seen in this approach. Certain stem designs and fixation methods may reduce the risk of PPFF via a DAA in primary THA.


Asunto(s)
Artroplastia de Reemplazo de Cadera/efectos adversos , Fijación de Fractura/métodos , Fracturas de Cadera/cirugía , Prótesis de Cadera/efectos adversos , Fracturas Periprotésicas/cirugía , Diseño de Prótesis/efectos adversos , Artroplastia de Reemplazo de Cadera/instrumentación , Artroplastia de Reemplazo de Cadera/métodos , Cementos para Huesos , Cementación , Fracturas de Cadera/etiología , Fracturas de Cadera/terapia , Humanos , Fracturas Periprotésicas/etiología , Reoperación
9.
Nutrients ; 13(7)2021 Jul 13.
Artículo en Inglés | MEDLINE | ID: mdl-34371911

RESUMEN

BACKGROUND: The aim of this work was to assess whether the muscle thickness and echogenicity were associated with dysphagia, malnutrition, sarcopenia, and functional capacity in acute hospital admission for a hip fracture. METHODS: Observational study that assessed nutritional status by Global Leadership Initiative on Malnutrition, risk of dysphagia and sarcopenia by European Working Group on Sarcopenia in Older People and Barthel functional index. We measured muscle thickness and echogenicity of masseter, bicipital, and quadriceps rectus femoris (RF) and vastus intermedius (VI) by ultrasound. RESULTS: One hundred and one patients were included in the study (29.7% sarcopenia and 43.8% malnutrition). Logistic regression models adjusted for age, sex, and body mass index showed an inverse association of the masseter thickness with both sarcopenia (OR: 0.56) and malnutrition (OR: 0.38) and quadriceps with sarcopenia (OR: 0.74). In addition, patients at high risk of dysphagia had lower masseter thickness (p: 0.0001) while patients able to self-feeding had thicker biceps (p: 0.002) and individuals with mobility on level surfaces higher thickness of biceps (p: 0.008) and quadriceps (p: 0.04). CONCLUSION: Thickness of the masseter was associated with risk of dysphagia, biceps with the ability to self-feed, and that of the quadriceps RF-VI with mobility.


Asunto(s)
Composición Corporal , Fracturas de Cadera/terapia , Hospitalización , Desnutrición/diagnóstico por imagen , Músculo Esquelético/diagnóstico por imagen , Estado Nutricional , Sarcopenia/diagnóstico por imagen , Ultrasonografía , Factores de Edad , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Estado Funcional , Fracturas de Cadera/diagnóstico por imagen , Fracturas de Cadera/epidemiología , Humanos , Pacientes Internos , Masculino , Desnutrición/epidemiología , Desnutrición/fisiopatología , Músculo Esquelético/fisiopatología , Valor Predictivo de las Pruebas , Prevalencia , Medición de Riesgo , Factores de Riesgo , Sarcopenia/epidemiología , Sarcopenia/fisiopatología , España/epidemiología
10.
Isr Med Assoc J ; 23(8): 475-478, 2021 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-34392620

RESUMEN

BACKGROUND: The coronavirus disease-2019 (COVID-19) pandemic had enormous impact on many aspects of our society, including huge medical, social, and economic challenges. OBJECTIVES: To evaluate the impact of the first wave of the COVID-19 pandemic and the related movement restrictions on the incidence of hip fractures in different age groups. METHODS: This single center retrospective observational study included all patients over 60 years old admitted to our hospital with the diagnosis of hip fracture during March and April 2020. Exclusion criteria were periprosthetic or pathologic fractures and multitrauma. We collected the same data on all patients with hip fractures admitted during March and April of 2018 and 2019. RESULTS: Mean patient age increased from 81.7 to 85.0 years. Only two of 49 patients tested positive for COVID-19. The data show a decrease of 38% in fracture load, but a striking decrease of 85% and 59% among sexagenarians and septuagenarian, respectively. There was no decrease among nonagenarians. Early mortality, both at 30 days and 90 days, was twice as common during the pandemic. However, stratification by age group demonstrated that the risks of early mortality were the same as previous years. Mean waiting time for surgery decreased from 27.5 to 18.9 hours. Patient discharge to home over a rehabilitation facility increased from 9% to 17. CONCLUSIONS: The COVID-19 pandemic affected the epidemiology of hip fractures in the elderly. The incidence of fractures and age distribution were significantly different from other years. Discharge destinations were also affected. The management of hip fracture patients was not compromised.


Asunto(s)
COVID-19 , Fracturas de Cadera , Manejo de Atención al Paciente , Factores de Edad , Anciano , Anciano de 80 o más Años , COVID-19/epidemiología , COVID-19/prevención & control , Femenino , Fracturas de Cadera/mortalidad , Fracturas de Cadera/rehabilitación , Fracturas de Cadera/terapia , Humanos , Incidencia , Control de Infecciones/métodos , Israel/epidemiología , Masculino , Persona de Mediana Edad , Mortalidad , Evaluación de Procesos y Resultados en Atención de Salud , Manejo de Atención al Paciente/métodos , Manejo de Atención al Paciente/tendencias , Estudios Retrospectivos , Medición de Riesgo/métodos , Medición de Riesgo/estadística & datos numéricos , SARS-CoV-2/aislamiento & purificación
11.
Arch Osteoporos ; 16(1): 120, 2021 08 17.
Artículo en Inglés | MEDLINE | ID: mdl-34405278

RESUMEN

Hip fracture trajectories have not been examined for older adults in aged care or living in the community. Trajectories of health care use were defined by distinct predictive factors. These results can inform the development of targeted strategies to reduce health service use following hip fracture. OBJECTIVE: To examine hospital service use trajectories of older adults who were hospitalised for hip fracture and living in a residential aged care facility (RACF) or the community, and to identify factors predictive of trajectory group membership. These findings may inform future programmes aimed at reducing unexpected hospitalisations and subsequently reduce health care costs. METHODS: A group-based trajectory analysis of hospitalisations was conducted for adults aged ≥ 65 years hospitalised for hip fracture during 2008-2009 in New South Wales, Australia. Linked hospitalisation and RACF data were examined for a 5-year period. Group-based trajectory models were derived for RACF and community-dwelling older adults based on the number of subsequent hospital admissions following the index hip fracture. Multinomial logistic regression examined predictors of trajectory group membership for subsequent hospital admissions. RESULTS: There were 5752 hip fracture hospitalisations, with two-thirds of hip fractures occurring in community-dwellers. Key predictors of trajectory group membership for both RACF residents and community-dwellers were age group, sex, hospital length of stay and cognitive impairment. Assistance with activities of daily living and complex health care needs were also predictive of group membership in RACF residents. Location of residence and time to move to a RACF were additional predictors of group membership for community-dwellers. CONCLUSION: Health service use trajectories differed for RACF residents and community-dwellers; however, there were similar patient characteristics that defined trajectory group membership. Low users of hospital services living in RACFs or the community included older adults with generally unfavourable health conditions, potentially indicating that palliative care or advanced care directives and community-care initiatives, respectively, have played a part in the lowered frequency of rehospitalisation.


Asunto(s)
Fracturas de Cadera , Readmisión del Paciente , Actividades Cotidianas , Anciano , Atención a la Salud , Fracturas de Cadera/epidemiología , Fracturas de Cadera/terapia , Hospitalización , Humanos
13.
Arch Osteoporos ; 16(1): 103, 2021 06 26.
Artículo en Inglés | MEDLINE | ID: mdl-34176022

RESUMEN

PURPOSE: Orthogeriatrics is a team approach that aims to provide adequate and timely intervention for individuals suffering from fragility fractures, particularly hip fractures. These patients are mostly the frailest older adults. The aim of orthogeriatrics is to re-gain functionality as early as possible and to decrease disability and mortality. Some developed countries have established orthogeriatric services, while many others, including Turkey, have so far not. Here, to identify areas for improvement, we outline the status of the orthogeriatrics in older adults in Turkey. METHODS: We present clear calls for action, emphasizing possible and noteworthy areas for improvement. RESULTS: Our proposals include the need for an easily applied, short version of comprehensive geriatric assessment; appropriate laboratory testing on admission; paracetamol with a special emphasis in its dosings and clues for state-of-the-art analgesic management; the essential need to introduce oral nutritional supplementation, irrespective of nutritional status; the need for vitamin D commencement, in almost all patients; and starting osteoporosis treatment in fracture hospitalization, whenever appropriate. Last but not least, the ever-increasing prerequisite to establish "fracture liaison services" is stipulated. CONCLUSION: We suggest that our recommendations offer great potential in Turkey, for the improvement of frail fracture patients' care. We call the other countries that do not have established orthogeriatric lines to model our approach to improve the management of fracture patients globally.


Asunto(s)
Servicios de Salud para Ancianos , Fracturas de Cadera , Fracturas Osteoporóticas , Anciano , Anciano Frágil , Fracturas de Cadera/terapia , Hospitalización , Humanos , Fracturas Osteoporóticas/terapia , Turquia
14.
PLoS One ; 16(6): e0251894, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34129607

RESUMEN

INTRODUCTION: To date, it is unclear what the clinical benefit of cement augmentation in fixation for trochanteric fractures is. The aim of this meta-analysis is to compare cement augmentation to no augmentation in fixation of trochanteric femur fractures in the elderly patients (>65 years) following low energy trauma. METHODS: PubMed/Medline/Embase/CENTRAL/CINAHL were searched for both randomized clinical trials (RCT) and observational studies comparing both treatments. Effect estimates were pooled across studies using random effects models. Subgroup analysis was performed stratified by study design (RCTs and observational studies). The primary outcome is overall complication rate. Secondary outcomes include re-operation rate, mortality, operation duration, hospital stay, general quality of life, radiologic measures and functional hip scores. RESULTS: A total of four RCT's (437 patients) and three observational studies (293 patients) were included. The effect estimates of RCTs were equal to those obtained from observational studies. Cement augmentation has a significantly lower overall complication rate (28.3% versus 47.2%) with an odds ratio (OR) of 0.3 (95%CI 0.1-0.7). The occurrence of device/fracture related complications was the largest contributing factor to this higher overall complication rate in the non-augmented group (19.9% versus 6.0%, OR 0.2, 95%CI 0.1-0.6). Cement augmentation also carries a lower risk for re-interventions (OR 0.2, 95%CI 0.1-0.7) and shortens the hospital stay with 2 days (95%CI -2.2 to -0.5 days). The mean operation time was 7 minutes longer in the augmented group (95%CI 1.3-12.9). Radiological scores (lag screw/blade sliding mean difference -3.1mm, 95%CI -4.6 to -1.7, varus deviation mean difference -6.15°, 95%CI; -7.4 to -4.9) and functional scores (standardized mean difference 0.31, 95%CI 0.0-0.6) were in favor of cement augmentation. Mortality was equal in both groups (OR 0.7, 95%CI 0.4-1.3) and cement related complications were rare. CONCLUSION: Cement augmentation in fixation of trochanteric femoral fractures leads to fewer complications, re-operations and shorter hospital stay at the expense of a slightly longer operation duration. Cementation related complications occur rarely and mortality is equal between treatment groups. Based on these results, cement augmentation should be considered for trochanteric fractures in elderly patients.


Asunto(s)
Cementos para Huesos/uso terapéutico , Fracturas de Cadera/terapia , Anciano de 80 o más Años , Clavos Ortopédicos , Tornillos Óseos , Cementación/métodos , Femenino , Fémur , Fijación Interna de Fracturas/métodos , Fijación Intramedular de Fracturas/métodos , Humanos , Masculino , Tempo Operativo , Ensayos Clínicos Controlados Aleatorios como Asunto , Reoperación/métodos
15.
Injury ; 52(7): 1851-1860, 2021 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-33985752

RESUMEN

BACKGROUND: Hip fracture is a common serious injury in older people and reducing readmission after hip fracture is a priority in many healthcare systems. Interventions which significantly reduce readmission after hip fracture have been identified and the aim of this review is to collate and summarise the efficacy of these interventions in one place. METHODS: In a rapid review of systematic reviews one reviewer (ELS) searched the Ovid SP version of Medline and the Cochrane Database of Systematic Reviews. Titles and abstracts of 915 articles were reviewed. Nineteen systematic reviews were included. (ELS) used a data extraction sheet to capture data on interventions and their effect on readmission. A second reviewer (RK) verified data extraction in a random sample of four systematic reviews. Results were not meta-analysed. Odds and risk ratios are presented where available. RESULTS: Three interventions significantly reduce readmission in elderly populations after hip fracture: personalised discharge planning, self-care and regional anaesthesia. Three interventions are not conclusively supported by evidence: Oral Nutritional Supplementation, integration of care, and case management. Two interventions do not affect readmission after hip fracture: Enhanced Recovery pathways and comprehensive geriatric assessment. CONCLUSIONS: Three interventions are most effective at reducing readmissions in older people: discharge planning, self-care, and regional anaesthesia. Further work is needed to optimise interventions and ensure the most at-risk populations benefit from them, and complete development work on interventions (e.g. interventions to reduce loneliness) and intervention components (e.g. adapting self-care interventions for dementia patients) which have not been fully tested yet.


Asunto(s)
Fracturas de Cadera , Readmisión del Paciente , Anciano , Fracturas de Cadera/terapia , Humanos , Alta del Paciente , Autocuidado , Revisiones Sistemáticas como Asunto
16.
BMC Geriatr ; 21(1): 224, 2021 04 01.
Artículo en Inglés | MEDLINE | ID: mdl-33794804

RESUMEN

BACKGROUND: This study describes the process evaluation of an intervention developed to reduce fear of falling (FoF) after hip fracture, within an inpatient geriatric rehabilitation setting. This 'FIT-HIP intervention' is a multicomponent cognitive behavioral intervention, conducted by physiotherapists and embedded in usual care in geriatric rehabilitation in the Netherlands. A previous study (cluster randomized controlled trial) showed no beneficial effects of this intervention when compared to usual care. The aim of this study was to gain insight into factors related to the intervention process that may have influenced the effectiveness of the intervention. METHODS: This process evaluation was conducted using an observational prospective study design. Based on quantitative and qualitative data derived from session logs, evaluation questionnaires and interviews, we addressed: 1] recruitment and reach; 2] performance according to protocol; 3] patients' adherence; and 4] opinions of patients and facilitators on the intervention. Participants in this study were: a) patients from 6 geriatric rehabilitation units, who were invited to participate in the intervention (39 adults aged ≥65 years with hip fracture and FoF) and; b) intervention facilitators (14 physiotherapists and 8 psychologists who provide coaching to the physiotherapists). RESULTS: Thirty-six patients completed the intervention during inpatient geriatric rehabilitation. Apart from cognitive restructuring and telephonic booster (which was not provided to all patients), the intervention was performed to a fair degree in accordance with protocol. Patients' adherence to the intervention was very good, and patients rated the intervention positively (average 8.1 on a scale 0-10). Although most facilitators considered the intervention feasible, a limited level of FoF (possibly related to timing of intervention), and physiotherapists' limited experience with cognitive restructuring were identified as important barriers to performing the intervention according to protocol. CONCLUSIONS: The FIT-HIP intervention was only partly feasible, which may explain the lack of effectiveness in reducing FoF. To improve the intervention's feasibility, we recommend selecting patients with maladaptive FoF (i.e. leading to activity restriction), being more flexible in the timing of the intervention, and providing more support to the physiotherapists in conducting cognitive restructuring. TRIAL REGISTRATION: Netherlands Trial Register: NTR5695 (7 March 2016).


Asunto(s)
Accidentes por Caídas , Cognición , Fracturas de Cadera , Accidentes por Caídas/prevención & control , Anciano , Miedo , Estudios de Factibilidad , Fracturas de Cadera/diagnóstico , Fracturas de Cadera/psicología , Fracturas de Cadera/terapia , Humanos , Países Bajos/epidemiología , Estudios Prospectivos
17.
Artículo en Inglés | MEDLINE | ID: mdl-33809573

RESUMEN

Hip fractures are an important socio-economic problem in western countries. Over the past 60 years orthogeriatric care has improved the management of older patients admitted to hospital after suffering hip fractures. Quality of care in orthogeriatric co-management units has increased, reducing adverse events during acute admission, length of stay, both in-hospital and mid-term mortality, as well as healthcare and social costs. Nevertheless, a large number of areas of controversy regarding the clinical management of older adults admitted due to hip fracture remain to be clarified. This narrative review, centered in the last 5 years, combined the search terms "hip fracture", "geriatric assessment", "second hip fracture", "surgery", "perioperative management" and "orthogeriatric care", in order to summarise the state of the art of some questions such as the optimum analgesic protocol, the best approach for treating anemia, the surgical options recommendable for each type of fracture and the efficiency of orthogeriatric co-management and functional recovery.


Asunto(s)
Servicios de Salud para Ancianos , Fracturas de Cadera , Anciano , Fracturas de Cadera/terapia , Hospitalización , Hospitales , Humanos , Tiempo de Internación
18.
Eur J Health Econ ; 22(6): 873-885, 2021 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-33813666

RESUMEN

BACKGROUND: Evidence suggests benefits of orthogeriatric co-management (OGCM) for hip fracture patients. Yet, evidence on cost-effectiveness is limited and based on small datasets. The aim of our study was to conduct an economic evaluation of the German OGCM for geriatric hip fracture patients. METHODS: This retrospective cohort study was based on German health and long-term care insurance data. Individuals were 80 years and older, sustained a hip fracture in 2014, and were treated in hospitals providing OGCM (OGCM group) or standard care (control group). Health care costs from payer and societal perspective, life years gained (LYG) and cost-effectiveness were investigated within 1 year. We applied weighted gamma and two-part models, and entropy balancing to account for the lack of randomisation. We calculated incremental cost-effectiveness ratios (ICER) and employed the net-benefit approach to construct cost-effectiveness acceptability curves. RESULTS: 14,005 patients were treated in OGCM, and 10,512 in standard care hospitals. Total average health care costs per patient were higher in the OGCM group: €1181.53 (p < 0.001) from payer perspective, and €1408.21 (p < 0.001) from societal perspective. The ICER equalled €52,378.12/ LYG from payer and €75,703.44/ LYG from societal perspective. The probability for cost-effectiveness would be 95% if the willingness-to-pay was higher than €82,000/ LYG from payer, and €95,000/ LYG from societal perspective. CONCLUSION: Survival improved in hospitals providing OGCM. Costs were found to increase, driven by inpatient and long-term care. The cost-effectiveness depends on the willingness-to-pay. The ICER is likely to improve with a longer follow-up.


Asunto(s)
Fracturas de Cadera , Seguro de Cuidados a Largo Plazo , Anciano , Análisis Costo-Beneficio , Costos de la Atención en Salud , Fracturas de Cadera/terapia , Humanos , Años de Vida Ajustados por Calidad de Vida , Estudios Retrospectivos
19.
Aging Clin Exp Res ; 33(6): 1439-1452, 2021 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-33821467

RESUMEN

As many as one out of three fragility fractures occur in older men and the outcome of major osteoporotic fractures, in particular hip fractures, is worse in men than in women. Osteoporosis in older men is thus an important threat to the quality of life of individual patients and a considerable burden for society. However, only a small minority of older men with high or very high fracture risk are receiving therapy. This does not need to be so as tools for fracture risk assessment are available and several drugs have been approved for treatment. Nevertheless, the evidence base for the management of osteoporosis in older men remains limited. This narrative review summarises the evidence for older men on the burden of osteoporosis, the pathophysiology of fragility fractures, the clinical presentation, diagnosis and risk assessment, the patient evaluation, and the non-pharmacological and pharmacological management.


Asunto(s)
Fracturas de Cadera , Osteoporosis , Fracturas Osteoporóticas , Anciano , Femenino , Fracturas de Cadera/epidemiología , Fracturas de Cadera/terapia , Humanos , Masculino , Osteoporosis/diagnóstico , Osteoporosis/tratamiento farmacológico , Fracturas Osteoporóticas/prevención & control , Calidad de Vida , Medición de Riesgo , Factores de Riesgo
20.
J Korean Med Sci ; 36(13): e87, 2021 Apr 05.
Artículo en Inglés | MEDLINE | ID: mdl-33821594

RESUMEN

BACKGROUND: The 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. METHODS: This 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. RESULTS: In 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. CONCLUSION: In 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.


Asunto(s)
Analgésicos Opioides/efectos adversos , Artroplastia de Reemplazo de Cadera , Trastornos Relacionados con Opioides/etiología , Adolescente , Adulto , Anciano , Analgésicos Opioides/uso terapéutico , Estudios de Cohortes , Bases de Datos Factuales , Femenino , Fracturas de Cadera/terapia , Humanos , Masculino , Persona de Mediana Edad , Trastornos Relacionados con Opioides/epidemiología , Trastornos Relacionados con Opioides/mortalidad , Dolor Postoperatorio/tratamiento farmacológico , Modelos de Riesgos Proporcionales , República de Corea/epidemiología , Estudios Retrospectivos , Factores de Riesgo , Tramadol/efectos adversos , Tramadol/uso terapéutico , Adulto Joven
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