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BMC Musculoskeletal Disorders

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Open Access 01-12-2022 | Research

Effect of integrated management bundle on 1-year overall survival outcomes and perioperative outcomes in super elderly patients aged 90 and over with hip fracture: non-concurrent cohort study

Authors: Mingming Fu, Junfei Guo, Yaqian Zhang, Yuqi Zhao, Yingze Zhang, Zhiyong Hou, Zhiqian Wang

Published in: BMC Musculoskeletal Disorders | Issue 1/2022

Abstract

Background

Due to concomitant factors like frailty and comorbidity, super elderly (≥90 years) patients with hip fracture differ from patients aged 65–89 years in perioperative complications and mortality. The integrated management bundle referred to bundled application of multiple clinical measures. The aim of this study was to analyze effect of integrated management bundle on 1-year overall survival and perioperative outcomes in super elderly patients with hip fracture, with multidisciplinary management group serving as the control group.

Methods

In this retrospective cohort study, super elderly patients with hip fracture were included from Jan 2017 to Nov 2020. Patients were retrospectively divided to multidisciplinary management group and integrated management bundle group. The primary outcome was 1- year overall survival, and the secondary outcome was perioperative outcomes. Kaplan-Meier methods was used to compare survival probability. Multivariable Cox’s modeling was used to explain the effect of integrated bundle on 1-year overall survival adjusted for confounders. The perioperative outcomes including complications and in-hospital data of two groups were compared. The multivariable logistic regression was used to explain the effect of integrated bundle on the occurrence of perioperative complications adjusted for confounders. Prognostic factors related to survival was identified by multivariable Cox’s regression analysis.

Results

Ninety-seven patients comprised multidisciplinary management group, and 83 comprised integrated management bundle group. The Kaplan–Meier plots showed that the survival probability of integrated management bundle group was significantly better than multidisciplinary management group (HR:0.435, 95%CI:0.207–0.914, P = 0.039). Multivariable analysis after adjustment for confounders showed a 42.8% lower incidence of mortality integrated management bundle group than multidisciplinary management group (HR:0.428, 95%CI:0.186–0.986, P = 0.046). Incidence of hypoproteinemia, and electrolyte disturbance in integrated management bundle group was significantly lower than multidisciplinary management group (all P < 0.05). In addition, significant reduction was observed in length of stay (P < 0.05) in integrated management bundle group. Multivariable logistic regression showed integrated management bundle was independent protective factor of hypoproteinemia, and electrolyte disturbance. mECM score ≥ 6 and ASA score > 2 were independent risk factors of overall survival (HR: 1.940, 95%CI: 1.067–3.525,P = 0.030; HR: 2.281, 95%CI: 1.113–4.678,P = 0.024).

Conclusions

The integrated management bundle improved 1-year overall survival and played positive effects in improving perioperative outcomes. It might be a more suitable management modality for super elderly patients with hip fracture.

Prince MJ, Wu F, Guo Y, Gutierrez Robledo LM, O'Donnell M, Sullivan R, et al. The burden of disease in older people and implications for health policy and practice. Lancet. 2015;385(9967):549–62.PubMedCrossRef

Saul D, Riekenberg J, Ammon JC, Hoffmann DB, Sehmisch S. Hip fractures: therapy, timing, and complication Spectrum. Orthop Surg. 2019;11(6):994–1002.PubMedPubMedCentralCrossRef

Boockvar KS, Halm EA, Litke A, Silberzweig SB, McLaughlin M, Penrod JD, et al. Hospital readmissions after hospital discharge for hip fracture: surgical and nonsurgical causes and effect on outcomes. J Am Geriatr Soc. 2003;51(3):399–403.PubMedCrossRef

Lizaur-Utrilla A, Serna-Berna R, Lopez-Prats FA, Gil-Guillen V. Early rehospitalization after hip fracture in elderly patients: risk factors and prognosis. Arch Orthop Trauma Surg. 2015;135(12):1663–7.PubMedCrossRef

Guo J, Wang Z, Fu M, Di J, Zha J, Liu J, et al. Super elderly patients with intertrochanteric fractures do not predict worse outcomes and higher mortality than elderly patients: a propensity score matched analysis. Aging (Albany NY). 2020;12(13):13583–93.CrossRef

Invernizzi M, de Sire A, D'Andrea F, Carrera D, Reno F, Migliaccio S, et al. Effects of essential amino acid supplementation and rehabilitation on functioning in hip fracture patients: a pilot randomized controlled trial. Aging Clin Exp Res. 2019;31(10):1517–24.PubMedCrossRef

Trevisan C, Gallinari G, Klumpp R, Menon A, Compagnoni R. Year to year comparison of 2000-2015 in hip fracture management: same survival rate despite older and more fragile patients. Aging Clin Exp Res. 2019;31(8):1097–103.PubMedCrossRef

Frenkel A, Zeldetz V, Gat R, Binyamin Y, Acker A, Frenkel M, et al. Atrial fibrillation and mortality in the oldest old after surgery for hip fractures. Gerontology. 2021;67(3):299–305.PubMedCrossRef

Guo J, Di J, Gao X, Zha J, Wang X, Wang Z, et al. Discriminative ability for adverse outcomes after hip fracture surgery: a comparison of three commonly used comorbidity-based indices. Gerontology. 2022;68(1):62–74.PubMedCrossRef

10.

Fu M, Zhang Y, Guo J, Zhao Y, Hou Z, Wang Z, et al. Application of integrated management bundle incorporating with multidisciplinary measures improved in-hospital outcomes and early survival in geriatric hip fracture patients with perioperative heart failure: a retrospective cohort study. Aging Clin Exp Res. 2022;34(5):1149–58.

11.

Patel JN, Klein DS, Sreekumar S, Liporace FA, Yoon RS. Outcomes in multidisciplinary team-based approach in geriatric hip fracture care: a systematic review. J Am Acad Orthop Surg. 2020;28(3):128–33.PubMedCrossRef

12.

Greenstein AS, Gorczyca JT. Orthopedic surgery and the geriatric patient. Clin Geriatr Med. 2019;35(1):65–92.PubMedCrossRef

13.

Zanker J, Duque G. Rapid geriatric assessment of hip fracture. Clin Geriatr Med. 2017;33(3):369–82.PubMedCrossRef

14.

Erickson KLB. Innovations in care of the elderly hip fracture patient; a nightmare no more. Nurs Clin North Am. 2020;55(2):149–61.PubMedCrossRef

15.

Bauer J, Biolo G, Cederholm T, Cesari M, Cruz-Jentoft AJ, Morley JE, et al. Evidence-based recommendations for optimal dietary protein intake in older people: a position paper from the PROT-AGE study group. J Am Med Dir Assoc. 2013;14(8):542–59.PubMedCrossRef

16.

Liu VX, Rosas E, Hwang J, Cain E, Foss-Durant A, Clopp M, et al. Enhanced recovery after surgery program implementation in 2 surgical populations in an integrated health care delivery system. JAMA Surg. 2017;152(7):e171032.PubMedPubMedCentralCrossRef

17.

Zhou K, Lai Y, Wang Y, Sun X, Mo C, Wang J, et al. Comprehensive pulmonary rehabilitation is an effective way for better postoperative outcomes in surgical lung cancer patients with risk factors: a propensity score-matched retrospective cohort study. Cancer Manag Res. 2020;12:8903–12.PubMedPubMedCentralCrossRef

18.

Liu Y, Fu M, Zhou Q, Tian M, Zhang X, Wang Z. The application of patient-centered care bundle significantly reduces incidence of perioperative respiratory complications in hip fracture patients aged 80 and over. Geriatr Nurs. 2022;43:213–8.PubMedCrossRef

19.

Vincent JL. Fluid management in the critically ill. Kidney Int. 2019;96(1):52–7.PubMedCrossRef

20.

Griffiths R, Babu S, Dixon P, Freeman N, Hurford D, Kelleher E, et al. Guideline for the management of hip fractures 2020: guideline by the Association of Anaesthetists. Anaesthesia. 2021;76(2):225–37.PubMedCrossRef

21.

Foss NB, Kristensen MT, Jensen PS, Palm H, Krasheninnikoff M, Kehlet H. The effects of liberal versus restrictive transfusion thresholds on ambulation after hip fracture surgery. Transfusion. 2009;49(2):227–34.PubMedCrossRef

22.

Gu WJ, Gu XP, Wu XD, Chen H, Kwong JSW, Zhou LY, et al. Restrictive versus Liberal strategy for red blood-cell transfusion: a systematic review and meta-analysis in Orthopaedic patients. J Bone Joint Surg Am. 2018;100(8):686–95.PubMedCrossRef

23.

Mak J, Wong E, Cameron I. Australian and new Zealand Society for Geriatric Medicine. Position statement--orthogeriatric care. Australas J Ageing. 2011;30(3):162–9.PubMedCrossRef

24.

De Vincentis A, Behr AU, Bellelli G, Bravi M, Castaldo A, Galluzzo L, et al. Orthogeriatric co-management for the care of older subjects with hip fracture: recommendations from an Italian intersociety consensus. Aging Clin Exp Res. 2021;33(9):2405–43.PubMedCrossRef

25.

Manosroi W, Atthakomol P, Isaradech N, Phinyo P, Vaseenon T. Preoperative correction of low hemoglobin levels can reduce 1-year all-cause mortality in osteoporotic hip fracture patients: a retrospective observational study. Clin Interv Aging. 2022;17:165–73.PubMedPubMedCentralCrossRef

26.

He W, You YY, Sun K, Xie C, Ming Y, Yu LN, et al. Admission delay is associated with worse surgical outcomes for elderly hip fracture patients: a retrospective observational study. World J Emerg Med. 2020;11(1):27–32.PubMedPubMedCentralCrossRef

27.

Atthakomol P, Manosroi W, Phinyo P, Pipanmekaporn T, Vaseenon T, Rojanasthien S. Prognostic factors for all-cause mortality in Thai patients with fragility fracture of hip: comorbidities and laboratory evaluations. Medicina (Kaunas, Lithuania). 2020;56(6):311.

28.

Atthakomol P, Manosroi W, Phinyo P, Pipanmekaporn T, Vaseenon T, Rojanasthien S. Predicting survival in Thai patients after low impact hip fracture using flexible parametric Modelling: a retrospective cohort study. J Clin Densitom. 2021;24(4):603–12.PubMedCrossRef

29.

van Walraven C, Austin PC, Jennings A, Quan H, Forster AJ. A modification of the Elixhauser comorbidity measures into a point system for hospital death using administrative data. Med Care. 2009;47(6):626–33.PubMedCrossRef

30.

Anbar R, Beloosesky Y, Cohen J, Madar Z, Weiss A, Theilla M, et al. Tight calorie control in geriatric patients following hip fracture decreases complications: a randomized, controlled study. Clin Nutr. 2014;33(1):23–8.PubMedCrossRef

31.

Desborough JP. The stress response to trauma and surgery. Br J Anaesth. 2000;85(1):109–17.PubMedCrossRef

32.

Pohlin F, Brabender K, Fluch G, Stalder G, Petit T, Walzer C. Seasonal variations in heart rate variability as an indicator of stress in free-ranging pregnant Przewalski's horses (E. ferus przewalskii) within the Hortobagy National Park in Hungary. Front Physiol. 2017;8:664.PubMedPubMedCentralCrossRef

33.

Chrousos GP. Stress and disorders of the stress system. Nat Rev Endocrinol. 2009;5(7):374–81.PubMedCrossRef

34.

Koolhaas JM, Bartolomucci A, Buwalda B, de Boer SF, Flugge G, Korte SM, et al. Stress revisited: a critical evaluation of the stress concept. Neurosci Biobehav Rev. 2011;35(5):1291–301.PubMedCrossRef

35.

Herman JP, McKlveen JM, Ghosal S, Kopp B, Wulsin A, Makinson R, et al. Regulation of the hypothalamic-pituitary-adrenocortical stress response. Compr Physiol. 2016;6(2):603–21.PubMedPubMedCentralCrossRef

36.

Deussing JM, Chen A. The Corticotropin-releasing factor family: physiology of the stress response. Physiol Rev. 2018;98(4):2225–86.PubMedCrossRef

37.

Lewis SK, Nachun D, Martin MG, Horvath S, Coppola G, Jones DL. DNA methylation analysis validates Organoids as a viable model for studying human intestinal aging. Cell Mol Gastroenterol Hepatol. 2020;9(3):527–41.PubMedCrossRef

38.

Li P, Li J, Lai Y, Wang Y, Wang X, Su J, et al. Perioperative changes of serum albumin are a predictor of postoperative pulmonary complications in lung cancer patients: a retrospective cohort study. J Thorac Dis. 2018;10(10):5755–63.PubMedPubMedCentralCrossRef

39.

Gopal DM, Kalogeropoulos AP, Georgiopoulou VV, Tang WW, Methvin A, Smith AL, et al. Serum albumin concentration and heart failure risk the health, aging, and body composition study. Am Heart J. 2010;160(2):279–85.PubMedPubMedCentralCrossRef

40.

Xu Q, Yan Y, Gu S, Mao K, Zhang J, Huang P, et al. A novel inflammation-based prognostic score: the fibrinogen/albumin ratio predicts prognoses of patients after curative resection for hepatocellular carcinoma. J Immunol Res. 2018;2018:4925498.PubMedPubMedCentral

41.

Evans DC, Corkins MR, Malone A, Miller S, Mogensen KM, Guenter P, et al. The use of visceral proteins as nutrition markers: an ASPEN position paper. Nutr Clin Pract. 2021;36(1):22–8.PubMedCrossRef

42.

Williams DGA, Ohnuma T, Haines KL, Krishnamoorthy V, Raghunathan K, Sulo S, et al. Association between early postoperative nutritional supplement utilisation and length of stay in malnourished hip fracture patients. Br J Anaesth. 2021;126(3):730–7.PubMedCrossRef

43.

Myint MW, Wu J, Wong E, Chan SP, To TS, Chau MW, et al. Clinical benefits of oral nutritional supplementation for elderly hip fracture patients: a single blind randomised controlled trial. Age Ageing. 2013;42(1):39–45.PubMedCrossRef

44.

Wyers CE, Reijven PLM, Breedveld-Peters JJL, Denissen KFM, Schotanus MGM, van Dongen M, et al. Efficacy of nutritional intervention in elderly after hip fracture: a multicenter randomized controlled trial. J Gerontol A Biol Sci Med Sci. 2018;73(10):1429–37.PubMedPubMedCentralCrossRef

45.

Title: Effect of integrated management bundle on 1-year overall survival outcomes and perioperative outcomes in super elderly patients aged 90 and over with hip fracture: non-concurrent cohort study
Authors: Mingming Fu
Junfei Guo
Yaqian Zhang
Yuqi Zhao
Yingze Zhang
Zhiyong Hou
Zhiqian Wang
Publication date: 01-12-2022
Publisher: BioMed Central
Published in: BMC Musculoskeletal Disorders / Issue 1/2022
Electronic ISSN: 1471-2474
DOI: https://doi.org/10.1186/s12891-022-05720-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Effect of integrated management bundle on 1-year overall survival outcomes and perioperative outcomes in super elderly patients aged 90 and over with hip fracture: non-concurrent cohort study

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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