Optimal preoperative timing for prevention of deep vein thrombosis (DVT) in patients over 60 years of age with intertrochanteric fractures.

PURPOSE: To investigate the incidence and risk factors of preoperative DVT in elderly patients with intertrochanteric fracture of the femur and determine the optimal preoperative time. METHODS: Electronic medical records of 358 patients over 60 years of age with intertrochanteric fractures from May 1, 2016, to May 1, 2019, were retrospectively analyzed. The preoperative group was divided into DVT and non-DVT. Univariate analysis was used for preliminary comparison, and multivariate logistic regression analysis was used to identify independent risk factors associated with DVT development. ROC curve was drawn to analyze the specificity and sensitivity of risk factors for DVT diagnosis. The diagnostic value of the model was analyzed by the ROC curve of multivariable combined diagnosis. RESULTS: A total of 358 patients who met the criteria were enrolled. The total prevalence of DVT before surgery was 8.38%. Multivariate logistic regression analysis showed that smoking status, preoperative time, albumin (ALB), D-dimer level, diabetes mellitus, and hypertension were independent risk factors for preoperative DVT. Preoperative time has the best sensitivity and specificity for diagnosing the occurrence of preoperative DVT. The ROC curve analysis model of multivariable combined diagnosis has a better diagnostic value. CONCLUSIONS: In this study, elderly patients with intertrochanteric femur fracture had a higher incidence of deep vein thrombosis before surgery. Early identification of DVT-related risk factors may contribute to individualized risk assessment and preventing adverse outcomes in patients with intertrochanteric fractures.

Preoperative walking recommendation for non-cardiac surgery patients to reduce the length of hospital stay: a randomized control trial.

BACKGROUND: Even though the importance of preparing patients for a surgical event is recognized, there are still gaps about the benefit of improving functional capacity by walking during the waiting time among patients scheduled for non-cardiac surgery. The aim of this study was to evaluate the impact of pre-surgical walking in-hospital length of stay, early ambulation, and the appearance of complications after surgery among patients scheduled for non-cardiac surgery. METHODS: A two-arm, single- blinded randomized controlled trial was developed from May 2016 to August 2017. Eligible outpatients scheduled for non-cardiac surgery, capable of walking, were randomized (2:1 ratio) to receive a prescription of walking 150 min/week during the whole pre-surgical waiting time (n = 249) or conventional care (n = 119). The primary outcome was the difference in hospital length of stay, and secondary results were time to first ambulation during hospitalization, description of ischemic events during hospitalization and after six months of hospital discharge, and the walking continuation. We performed an intention to treat analysis and compared length of stay between both groups by Kaplan-Meier estimator (log-rank test). RESULTS: There were no significant differences in the length of hospital stay between both groups (log-rank test p = 0.367) and no differences in the first ambulation time during hospitalization (log-rank test p = 0.299). Similar rates of postoperative complications were observed in both groups, but patients in the intervention group continued to practice walking six months after discharge (p < 0.001). CONCLUSION: Our study is the first clinical trial evaluating the impact of walking before non-cardiac surgery in the length of stay, early ambulation, and complications after surgery. Prescription of walking for patients before non-cardiac surgery had no significant effect in reducing the length of stay, and early ambulation. The results become a crucial element for further investigation. TRIAL REGISTRATION: PAMP-Phase2 was registered in ClinicalTrials.gov NCT03213496 on July 11, 2017.

Pain relief after more than 24 hours of preoperative skin traction in patients with intertrochanteric fractures: A retrospective comparative cohort study.

AIM: The primary aim of the study was to investigate pain relief after more than 24 h of preoperative skin traction (because of delay in surgery due to comorbidities and system issues) in patients with intertrochanteric fractures. METHOD: We performed a retrospective comparative cohort study of 56 patients who underwent intramedullary nailing for the treatment of intertrochanteric fractures and who had waited for surgery for more than 48 h after admission due to comorbidities or system issues. Preoperative therapy was randomly selected with a ratio of one to two and patients classified as skin traction (n = 18) or no traction (n = 38). The Verbal Rating Scale (VRS) was used to assess pain at 12-60 h post-admission. RESULTS: There was no significant difference in VRS at 12 h after admission (1.1 ± 1.0 vs. 0.8 ± 0.9, p = 0.73), but patients who received skin traction had a lower VRS pain score at 24-60 h after admission compared to those with no traction (24 h, 0.4 ± 0.8 vs. 1.1 ± 1.0, p < 0.05; 36 h, 0.2 ± 0.5 vs. 0.9 ± 0.9, p < 0.05; 48 h, 0.2 ± 0.4 vs. 0.8 ± 0.9, p < 0.05; 60 h, 0.2 ± 0.4 vs. 0.9 ± 0.9, p < 0.05). CONCLUSION: Skin traction for patients with intertrochanteric fractures for more than 24 h preoperatively resulted in a lower VRS pain score. Therefore, more than 24 h of preoperative skin traction for patients with intertrochanteric fractures may give effective pain relief in situations where surgery is delayed.