Michael Rozenfeld1, Moran Bodas2, Michal Shani3, Irina Radomislensky4, Havi Murad5, Doron Comaneshter6, Avi Israeli7, Kobi Peleg2. 1. National Center for Trauma & Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Tel-Hashomer 52621, Israel. Electronic address: michaelr@gertner.health.gov.il. 2. National Center for Trauma & Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Tel-Hashomer 52621, Israel; Emergency and Disaster Management Department, Faculty of Medicine, School of Public Health, Tel-Aviv University, Israel. 3. Department of Family Medicine, Central District, Clalit Health Services, Israel; Department of Family Medicine, Sakler School of Medicine, Tel Aviv University, Israel. 4. National Center for Trauma & Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Tel-Hashomer 52621, Israel. 5. Biostatistics Unit, Gertner Institute for Epidemiology and Health Policy Research, Tel-Hashomer, Israel. 6. Clalit Health Services Headquarter, Community Division, Clalit Health Services, Tel Aviv, Israel. 7. Hebrew University, Hadassah School of Public Health, Jerusalem, Israel.
Abstract
OBJECTIVE: To estimate the potential influence of pre-operative patient condition on the benefit of earlier hip fracture surgery for elderly patients. BACKGROUND: Many studies emphasize the benefit of earlier hip fracture surgery for patient survival. However less is known regarding how this relationship is influenced by clinical factors which could serve as potential contra-indicators for earlier surgery. Rushed surgery of patients with contra-indications may even compromise their survival. METHODS: A retrospective study of patients aged 65 and above with an isolated hip fracture following trauma, based on data from 19 hospitals of the national trauma registry available for the years 2015-2016. Registry data was crossed with data on co-morbidities and medication intake from the biggest health insurance agency in the country, serving more than 50% of the country's population. Mediation analysis was performed on a wide list of co-morbidities, medications and clinical test results in order to establish the mediation of their relationship with inhospital mortality by earlier hip fracture surgery. Factors found significant in the mediation analysis were utilized to adjust a logistic regression for predicting inhospital mortality by function of waiting time to surgery and patient's sex and age. RESULTS: Anti-coagulant and anti-platelet intake; test results pointing to decreased kidney function and being diagnosed with diabetes or Ischemic Heart Disease were found to be significantly mediated in their influence on inhospital mortality by hip fracture surgery. Despite anti-platelet intake and kidney function having a significant impact on mortality in the multi-variate analysis, the positive effect of earlier hip surgery on survival remained unchanged after adjustment. CONCLUSIONS: Earlier hip fracture surgery was found to be beneficial for elderly patients even when their co-morbidities and medication intake are taken into account.
OBJECTIVE: To estimate the potential influence of pre-operative patient condition on the benefit of earlier hip fracture surgery for elderly patients. BACKGROUND: Many studies emphasize the benefit of earlier hip fracture surgery for patient survival. However less is known regarding how this relationship is influenced by clinical factors which could serve as potential contra-indicators for earlier surgery. Rushed surgery of patients with contra-indications may even compromise their survival. METHODS: A retrospective study of patients aged 65 and above with an isolated hip fracture following trauma, based on data from 19 hospitals of the national trauma registry available for the years 2015-2016. Registry data was crossed with data on co-morbidities and medication intake from the biggest health insurance agency in the country, serving more than 50% of the country's population. Mediation analysis was performed on a wide list of co-morbidities, medications and clinical test results in order to establish the mediation of their relationship with inhospital mortality by earlier hip fracture surgery. Factors found significant in the mediation analysis were utilized to adjust a logistic regression for predicting inhospital mortality by function of waiting time to surgery and patient's sex and age. RESULTS: Anti-coagulant and anti-platelet intake; test results pointing to decreased kidney function and being diagnosed with diabetes or Ischemic Heart Disease were found to be significantly mediated in their influence on inhospital mortality by hip fracture surgery. Despite anti-platelet intake and kidney function having a significant impact on mortality in the multi-variate analysis, the positive effect of earlier hip surgery on survival remained unchanged after adjustment. CONCLUSIONS: Earlier hip fracture surgery was found to be beneficial for elderly patients even when their co-morbidities and medication intake are taken into account.
Authors: Bruno Silva Tavares; Rafael DE Almeida Machado; Ulisses Tavares DE Arruda; Leandro Alves DE Oliveira Journal: Acta Ortop Bras Date: 2022-08-26 Impact factor: 0.683