Impact of postoperative intravenous iron therapy on postoperative infections in older patients with severe anaemia after hip fracture surgery.

BACKGROUND: Anaemia is common following hip fracture in ortho-geriatric patients and is associated with postoperative infections.. This study investigated whether intravenous iron supplements reduced the rate of postoperative infections within 30 days postoperatively in older adults after hip fracture surgery. METHODS: This observational study included 198 ortho-geriatric patients July 2018-May 2020. In May 2019 a local guideline was implemented and recommended II therapy on the 3rd postoperative day if haemoglobin concentration was < 6.5 mmol/L after hip fracture surgery. RESULTS: The patients were divided into four treatment groups: blood transfusion (n = 44), IV iron (n = 69), blood transfusion + IV iron (n = 35) and no treatment (n = 50). The number of patients who had an infection within 30 days was similar in the two time periods (38.8% before vs. 38.9% after systematic I.V. iron supplementation, P = 1.00) and no significant difference according to risk of infection was found between treatment groups. CONCLUSION: This study documents no effect of intravenous iron supplements on postoperative infections in older adults after hip fracture surgery. TRIAL REGISTRATION: The study was registered with the Danish Data Protection Authority (2008-58-0028) the 2th of September 2019.

Association between intravenous iron therapy and short-term mortality risk in older patients undergoing hip fracture surgery: an observational study.

BACKGROUND: Anemia is common among ortho-geriatric hip fracture patients and is associated with prolonged recovery and increased postoperative mortality rate. Intravenous iron seems to increase hemoglobin recovery and reduce the mortality rate in patients undergoing orthopedic surgeries. This study investigated the association between short-term mortality risk and intravenous iron therapy in older patients undergoing hip fracture surgery. METHODS: This observational study included 210 patients undergoing hip fracture surgery from July 2018 to May 2020. These 210 patients were alive and had a hemoglobin ≤ 6.5 mmol/L on the 3rd postoperative day. In May 2019, a local intravenous iron therapy protocol was implemented and recommended intravenous iron (Monofer©) if hemoglobin on the 3rd postoperative day was ≤ 6.5 mmol/L. According to the treatment of postoperative anemia between the 1st and 3rd day post-surgery, the patients were divided into four groups: no treatment (n=52), blood transfusion (n=38), IV Monofer (n=80), and blood transfusion and IV Monofer (n=40). Primary outcome was 30-day mortality post-surgery. The secondary outcome was the impact on hemoglobin level 14-30 days postoperatively. Multivariable Cox regression was used to estimate the 30-day mortality standardized for covariates. RESULTS: Of 210 patients, 17 (8.1%) died within 30 days after surgery. There was a significantly lower mortality among the patients who received IV Monofer compared to those who received no treatment (HR 0.17, 95% CI [0.03-0.93], P = 0.041). Among the 86 patients with available hemoglobin measurements within 14 to 30 days post-surgery, there was no significant difference in hemoglobin level between the various treatment groups (mean 6.6 mmol/L, P = 0.1165). CONCLUSION: IV Monofer on the 3rd postoperative day in older hip fracture patients seemed to reduce 30-day mortality compared with no treatment. No significant differences in hemoglobin levels between 14 and 30 days post-surgery across treatment groups were found, although this was assessed in a subset of patients with available hemoglobin levels warranting further study.

Validity of the GAITRite Walkway Compared to Functional Balance Tests for Fall Risk Assessment in Geriatric Outpatients.

This study examined the concurrent validity between gait parameters from the GAITRite walkway and functional balance test commonly used in fall risk assessment. Patients were sampled from one geriatric outpatient clinic. One physiotherapist evaluated the patients on the GAITRite walkway with three repetitions in both single- and dual-task conditions. Patients were further evaluated with Bergs Balance scale (BBS), Dynamic Gait index (DGI), Timed Up and Go (TUG), and Sit To Stand test (STS). Correlations between quantitative gait parameters and functional balance test were analyzed with Spearman's rank correlations. Correlations strength was considered as follows: negligible <0.1, weak 0.10-0.39, moderate 0.40-0.69, and strong ≥0.70. We included 24 geriatric outpatients in the study with a mean age of 80.6 years (SD: 5.9). Patients received eight (SD: 4.5) different medications on average, and seven (29.2%) patients used walkers during ambulation. Correlations between quantitative gait parameters and functional balance test ranged from weak to moderate in both single- and dual-task conditions. Moderate correlations were observed for DGI, TUG, and BBS, while STS showed weak correlations with all GAITRite parameters. For outpatients analyzed on the GAITRite while using walkers, correlations showed no clear pattern across parameters with large variation within balance tests.

DEMMI Scores, Length of Stay, and 30-Day Readmission of Acute Geriatric Patients in Denmark: A Cross-Sectional Observational Study with Longitudinal Follow-Up.

The aims of this study are to describe the mobility of acute geriatric patients, the length of stay, and to characterise patients who were readmitted within 30 days based on the De Morton Mobility Index (DEMMI). A cross-sectional observational study with longitudinal follow-up was conducted in the period from 1 March 2016 to 31 August 2016. Inclusion criteria were acute geriatric patients hospitalised for a minimum of 24 h. Of the 418 patients hospitalised during the study period, 246 (59%) participated in this study (44% male, median age 83 years [70; 94]). For patients in an acute geriatric department, the median DEMMI score was 41 and the mean score was 39.95. Patients with a DEMMI score ≤40 show a significantly lower Barthel 100 index, lower 30 s. sit-to-stand scores and were significantly more likely to be bedridden or, amongst those not bedridden, to use a mobility aid. Lower DEMMI scores were associated with longer admissions. DEMMI seems to have the ability to predict discharge within one week. There was no significant association between a lower DEMMI score and higher risk for 30-day readmission. Further research is needed to determine whether the DEMMI is suitable for identifying the patient's need for further rehabilitation following the discharge.

The Prevalence of Oropharyngeal Dysphagia in Acute Geriatric Patients.

Oropharyngeal dysphagia (OD) is underdiagnosed and undertreated in many geriatric centers. The aim of this study is to explore the prevalence of OD in acute geriatric patients. The outcome was mortality during hospitalization, mortality, and rehospitalization within 0⁻30 and 31⁻180 days of discharge. A total of 313 consecutive acute geriatric patients (44.1% male, mean age 83.1 years (SD 7.8)) hospitalized from 1 March to 31 August 2016 in the North Denmark Regional Hospital were included in this study. The volume-viscosity swallow test and the Minimal Eating Observation Form-II were conducted for each patient in order to screen for OD. A total of 50% patients presented with OD. In the group of patients with OD, significantly more lived in nursing homes; had a lower weight, DEMMI score, and handgrip strength; and smaller circumference of arms and legs compared with non-dysphagia patients. Patients with OD presented an increased length of stay in hospital of one day (p = 0.70). Intra-hospital mortality was 5.8% vs. 0.7%, (p < 0.001) compared with patients with no symptoms of OD. OD is prevalent in acute geriatric patients, and the mortality is 34% within six months of hospitalization. Screening for OD should be given more attention and included in geriatric guidelines.

[The effect of geriatric intervention on rehabilitation of elderly patients with hip fracture]. / Effekten af geriatrisk intervention på rehabilitering af aeldre patienter med hoftefraktur.

INTRODUCTION: Hip fracture is the most common cause of long hospitalisation among elderly and is increasing in the group of elderly aged 85+ years. Hip fractures are associated with a host of factors and mainly caused by falls and osteoporosis. MATERIAL AND METHODS: The Geriatric Team of the orthopaedic ward, geriatric rehabilitation and follow-home function (GO) is compared to traditional orthopaedic treatment (ORT) among elderly aged 65+ with respect to: haemoglobin difference before surgery and 3-6 months after fracture, osteoporosis treatment, length of stay, change in accommodation, readmission and mortality within six months after admission and incidence of new fracture within two years. RESULTS: Median length of stay was reduced from 15 till 13 days. Significantly more were treated with calcium/D-vitamin and bisphosphonate. The risk of a new fracture within two years was lower (incidence rate ratio = 0,72 (95% confidence interval (CI: 0,39-1,32)). Geriatric intervention did not reduce readmission (odds ratio (OR)= 1,09 (95% CI: 0,71-1,67)) and mortality (OR = 1,22 (95% CI: 0,71-2,11)). CONCLUSION: A combined geriatric orthopaedic effort in elderly with hip fracture seems to improve the quality as well as the efficiency of treatment. The concept would benefit from further development and combination with other initiatives aimed at accelerating the treatment pathway of the elderly.