Orthopedic Surgery in Rheumatoid Arthritis: Results from the Spanish National Registry of Hospitalized Patients over 17 Years.

OBJECTIVE: To analyze the trend of orthopedic surgery (OS) rates on patients with rheumatoid arthritis (RA). METHODS: Retrospective observational study based on information provided by the Spanish National System of Hospital Data Surveillance. All hospitalizations of patients with RA for orthopedic surgery [total hip arthroplasty (THA), total knee arthroplasty (TKA), arthrodesis, and upper limb arthroplasty (ULA)] during 1999-2015 were analyzed. The age-adjusted rate was calculated. Generalized linear models were used for trend analysis. RESULTS: There were 21,088 OS in patients over 20 years of age (77.9% women). OS rate adjusted by age was 754.63/100,000 RA patients/year (women 707.4, men 861.1). Neither an increasing nor a decreasing trend was noted for the total OS. However, trend and age interacted, so in the age ranges 20-40 years and 40-60 years, an annual reduction of 2.69% and 2.97%, respectively, was noted. In the age ranges over 80 years and 60-80 years, we noted an annual increase of 5.40% and 1.09%, respectively. The average age at time of OS increased 5.5 years during the period analyzed. For specific surgeries, a global annual reduction was noted in rates for arthrodesis. In THA, there was an annual reduction in patients under 80 years. In TKA and ULA, there was an annual reduction in patients under 60 years. CONCLUSION: Although the overall OS rate has not changed, there is a decrease in the rate of arthrodesis at all ages, THA in patients under 80 years of age, as well as TKA and ULA in patients under 60 years of age.

Mortality after osteoporotic hip fracture: incidence, trends, and associated factors.

BACKGROUND: It is known that mortality after hip fracture increases compared to the general population; the trend in mortality is a controversial issue. The objective of this study is to examine incidence, trends, and factors associated with mortality in patients with osteoporotic hip fractures. METHODS: This is a retrospective cohort study that uses the Registry for Hospital Discharges of the National Health System of our hospital. Patients older than 45 having an osteoporotic hip fracture between 1999 and 2015 were identified. Demographic data and comorbidities were obtained. A survival analysis was performed (Cox regression and Kaplan-Meier). Incidence rate, standardized death rate (SDR), trend (Poisson regression), and risk (hazard ratio) were calculated. RESULTS: During 1999-2015, in our hospital, there were a total of 3992 patients admitted due to osteoporotic hip fracture. Out of these 3992 patients, 3109 patients (77.9%) were women with an average age of 84.47 years (SD 8.45) and 803 (22.1%) were men with an average age of 81.64 years (SD 10.08). The cumulative incidence of mortality was 69.38%. The cumulative mortality rate for 12 months was 33%. The annual mortality was 144.9/1000 patients/year. The 1-year mortality rate increased significantly by 2% per year (IRR 1.020, CI95% 1.008-1.033). The median overall survival was 886 days (CI95% 836-951). The probability of mortality density for a period of 10 years following a hip fracture was 16% for women and 25% for men (first 90 days). The SDR was 8.3 (CI95% 7.98-8.59). Variables that showed statistically significant association with mortality were aged over 75, masculine, institutionalization, mild to severe liver disease, chronic kidney disease, COPD, dementia, heart failure, diabetes, the Charlson Index > 2 , presence of vision disorders and hearing impairment, incontinence, and Downton scale. CONCLUSIONS: For the last 17 years, an increase of mortality for patients with hip fracture and a higher mortality rate in men than in women were observed. Institutionalization combined with comorbidities is associated with a higher mortality.

Trends in hip fracture in patients with rheumatoid arthritis: results from the Spanish National Inpatient Registry over a 17-year period (1999-2015). TREND-AR study.

PURPOSE: To analyse trends in hip fracture (HF) rates in patients with rheumatoid arthritis (RA) over an extended time period (17 years). METHODS: This observational retrospective survey was performed by reviewing data from the National Surveillance System for Hospital Data, which includes more than 98% of Spanish hospitals. All hospitalisations of patients with RA and HF that were reported from 1999 to 2015 were analysed. Codes were selected using the Ninth International Classification of Diseases, Clinical Modification: ICD-9-CM: RA 714.0 to 714.9 and HF 820.0 to 820.3. The crude and age-adjusted incidence rate of HF was calculated by age and sex strata over the last 17 years. General lineal models were used to analyse trends. RESULTS: Between 1999 and 2015, 6656 HFs occurred in patients with RA of all ages (84.25% women, mean age 77.5 and 15.75% men, mean age 76.37). The age-adjusted osteoporotic HF rate was 221.85/100 000 RA persons/ year (women 227.97; men 179.06). The HF incidence rate increased yearly by 3.1% (95% CI 2.1 to 4.0) during the 1999-2015 period (p<0.001) and was more pronounced in men (3.5% (95% CI 2.1 to 4.9)) than in women (3.1% (95% CI 2.3 to 4.1)). The female to male ratio decreased from 1.54 in 1999 to 1.14 in 2015. The average length of hospital stays (ALHS) decreased (p<0.001) from 16.76 days (SD 15.3) in 1999 to 10.78 days (SD 7.72) in 2015. Age at the time of hospitalisation increased (p<0.001) from 75.3 years (SD 9.33) in 1999 to 79.92 years (SD 9.47) in 2015. There was a total of 326 (4.9%) deaths during admission, 247 (4.4%) in women and 79 (7.5%) in men (p<0.001). CONCLUSION: In Spain, despite the advances that have taken place in controlling disease activity and in treating osteoporosis, the incidence rate of HF increased in both male and female patients with RA.

Weather conditions and their effect on seasonality of incident osteoporotic hip fracture.

Our aim was to analyze the seasonality and the effect of weather conditions on the incidence of osteoporotic hip fracture in a Southern European region. INTRODUCTION: The objective of this work is to evaluate seasonality and the effect of weather conditions on the incidence of osteoporotic hip fracture in a Southern European region. METHODS: This retrospective cohort study included all patients admitted to Alcorcón Foundation University Hospital with a diagnosis of osteoporotic hip fracture between the years 1999 and 2015. In a time series analysis, we examined the association between hip fracture incidence and different weather conditions and seasonality using general additive models (with Poisson distribution). The incidence rate ratio (IRR) crude and adjusted by season was estimated for all parameters. Hip incidence was further analyzed by sex and age (below or over 75) subgroups. RESULTS: Four thousand two hundred seventy-one patients with an osteoporotic hip fracture were included (79% females, mean age 83.8). Season fracture rate was significantly higher in fall and winter (67.06 and 64.41 fractures/season) compared to summer and spring (59.71 and 60.06; p < 0,001). Hip fracture incidence was 15% greater in autumn and winter than in spring and summer. Fog [IRR 1.15 (95% CI: 1.003-1.33)], atmospheric pressure (per 100 mb) [IRR 1.05 (95% CI: 1.004-1.114)], and frost [IRR 1.15 (95% CI: 1.03-1.30)] were significantly associated with increased hip fracture. Haze [IRR 1.10 (95% CI: 0.99-1.23)] showed a trend without statistical significance. Daily average temperature (per 5 °C) [IRR 0.98 (95% CI: 0.957-0.996)], rain (per 10 ml) [IRR 0.99 (95% CI: 0.981-1.0)], wind speed [IRR = 0.952, (95% CI: 0.907-0.998)], and daily ultraviolet radiation (per 100 joules) [IRR 0.998 (95% CI: 0.996-1.0)] were negatively associated with fracture. After adjusting by season and trend, all these associations disappear. CONCLUSIONS: In this Southern region, hip fracture incidence exhibits a seasonal pattern different from those communicated in Northern regions. There is short-term association with different weather conditions that partly explain this seasonal pattern.