BACKGROUND: Limited information is available on preoperative status and risks for complications for older patients having surgery for hip fracture. Our objective was to identify potentially modifiable clinical findings that should be considered in decisions about the timing of surgery. METHODS: We conducted a prospective cohort study with data obtained from medical records and through structured interviews with patients. A total of 571 adults with hip fracture who were admitted to 4 metropolitan hospitals were included. RESULTS: Multiple logistic regression was used to identify risk factors (including 11 categories of physical and laboratory findings, classified as mild and severe abnormalities) for in-hospital complications. The presence of more than 1 (odds ratio [OR] 9.7, 95% confidence interval [CI] 2.8 to 33.0) major abnormality before surgery or the presence of major abnormalities on admission that were not corrected prior to surgery (OR 2.8, 95% CI 1.2 to 6.4) was independently associated with the development of postoperative complications. We also found that minor abnormalities, while warranting correction, did not increase risk (OR 0.70, 95% CI 0.28 to 1.73). CONCLUSIONS: In this study of older adults undergoing urgent surgery, potentially reversible abnormalities in laboratory and physical examination occurred frequently and significantly increased the risk of postoperative complications. Major clinical abnormalities should be corrected prior to surgery, but patients with minor abnormalities may proceed to surgery with attention to these medical problems perioperatively.
BACKGROUND: Limited information is available on preoperative status and risks for complications for older patients having surgery for hip fracture. Our objective was to identify potentially modifiable clinical findings that should be considered in decisions about the timing of surgery. METHODS: We conducted a prospective cohort study with data obtained from medical records and through structured interviews with patients. A total of 571 adults with hip fracture who were admitted to 4 metropolitan hospitals were included. RESULTS: Multiple logistic regression was used to identify risk factors (including 11 categories of physical and laboratory findings, classified as mild and severe abnormalities) for in-hospital complications. The presence of more than 1 (odds ratio [OR] 9.7, 95% confidence interval [CI] 2.8 to 33.0) major abnormality before surgery or the presence of major abnormalities on admission that were not corrected prior to surgery (OR 2.8, 95% CI 1.2 to 6.4) was independently associated with the development of postoperative complications. We also found that minor abnormalities, while warranting correction, did not increase risk (OR 0.70, 95% CI 0.28 to 1.73). CONCLUSIONS: In this study of older adults undergoing urgent surgery, potentially reversible abnormalities in laboratory and physical examination occurred frequently and significantly increased the risk of postoperative complications. Major clinical abnormalities should be corrected prior to surgery, but patients with minor abnormalities may proceed to surgery with attention to these medical problems perioperatively.
Authors: Kim A Eagle; Peter B Berger; Hugh Calkins; Bernard R Chaitman; Gordon A Ewy; Kirsten E Fleischmann; Lee A Fleisher; James B Froehlich; Richard J Gusberg; Jeffrey A Leppo; Thomas Ryan; Robert C Schlant; William L Winters; Raymond J Gibbons; Elliott M Antman; Joseph S Alpert; David P Faxon; Valentin Fuster; Gabriel Gregoratos; Alice K Jacobs; Loren F Hiratzka; Richard O Russell; Sidney C Smith Journal: Circulation Date: 2002-03-12 Impact factor: 29.690
Authors: L Goldman; D L Caldera; S R Nussbaum; F S Southwick; D Krogstad; B Murray; D S Burke; T A O'Malley; A H Goroll; C H Caplan; J Nolan; B Carabello; E E Slater Journal: N Engl J Med Date: 1977-10-20 Impact factor: 91.245
Authors: A S Detsky; H B Abrams; J R McLaughlin; D J Drucker; Z Sasson; N Johnston; J G Scott; N Forbath; J R Hilliard Journal: J Gen Intern Med Date: 1986 Jul-Aug Impact factor: 5.128
Authors: Gretchen M Orosz; Jay Magaziner; Edward L Hannan; R Sean Morrison; Kenneth Koval; Marvin Gilbert; Maryann McLaughlin; Ethan A Halm; Jason J Wang; Ann Litke; Stacey B Silberzweig; Albert L Siu Journal: JAMA Date: 2004-04-14 Impact factor: 56.272
Authors: Albert L Siu; Kenneth S Boockvar; Joan D Penrod; R Sean Morrison; Ethan A Halm; Ann Litke; Stacey B Silberzweig; Jeanne Teresi; Katja Ocepek-Welikson; Jay Magaziner Journal: Med Care Date: 2006-09 Impact factor: 2.983
Authors: Ingvild Saltvedt; Anders Prestmo; Elin Einarsen; Lars Gunnar Johnsen; Jorunn L Helbostad; Olav Sletvold Journal: BMC Res Notes Date: 2012-07-16