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European Journal of Trauma and Emergency Surgery

Published in:

12-07-2023 | Original Article

Liberal intraoperative fluid management leads to increased complication rates in geriatric patients with hip fracture

Authors: Bastian Pass, Denis Sieben, Fahd Malek, Bjoern Hussmann, Teresa Maek, Rene Aigner, Christopher Bliemel, Daniel Dirkmann, Sven Lendemans, Carsten Schoeneberg

Published in: European Journal of Trauma and Emergency Surgery | Issue 6/2023

Abstract

Purpose

Fractures of the proximal femur in geriatric patients are life-changing and life-threatening events. Previous research has identified fluid volume as an independent factor contributing to trauma patients’ complications. Therefore, we aimed to investigate the impact of intraoperative fluid volume on outcomes in geriatric patients undergoing hip fracture surgery.

Methods

We conducted a retrospective single-center study with data from the hospital information systems. Our study included patients aged 70 years or older who had sustained a proximal femur fracture. We excluded patients with pathologic, periprosthetic, or peri-implant fractures and those with missing data. Based on the fluids given, we divided patients into high-volume and low-volume groups.

Results

Patients with a higher American Society of Anesthesiologists (ASA) grade and more comorbidities were more likely to receive more than 1500 ml of fluids. We observed significant differences in anesthesiologic management between the two groups, with a higher rate of invasive blood pressure management (IBP) and central venous catheter usage in the high-volume group. High-volume therapy was associated with a higher rate of complications (69.7% vs. 43.6%, p < 0.01), a higher transfusion rate (odds ratio 1.91 [1.26–2.91]), and an increased likelihood of patients being transferred to an intensive care unit (17.1% vs. 6.4%, p = 0.009). These findings were confirmed after adjusting for ASA grade, age, sex, type of fracture, Identification-of-Seniors-At-Risk (ISAR) score, and intraoperative blood loss.

Conclusions

Our study suggests that intraoperative fluid volume is a significant factor that impacts the outcome of hip fracture surgery in geriatric patients. High-volume therapy was associated with increased complications.

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Title: Liberal intraoperative fluid management leads to increased complication rates in geriatric patients with hip fracture
Authors: Bastian Pass
Denis Sieben
Fahd Malek
Bjoern Hussmann
Teresa Maek
Rene Aigner
Christopher Bliemel
Daniel Dirkmann
Sven Lendemans
Carsten Schoeneberg
Publication date: 12-07-2023
Publisher: Springer Berlin Heidelberg
Published in: European Journal of Trauma and Emergency Surgery / Issue 6/2023
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-023-02326-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Liberal intraoperative fluid management leads to increased complication rates in geriatric patients with hip fracture

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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