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Archives of Orthopaedic and Trauma Surgery

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01-09-2021 | Trauma Surgery

Does preoperative hemodynamic preconditioning improve morbidity and mortality after traumatic hip fracture in geriatric patients? A retrospective cohort study

Authors: J. Q. Kusen, P. C. R. van der Vet, F. J. G. Wijdicks, B. C. Link, B. Poblete, D. van der Velde, R. Babst, F. J. P. Beeres

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 9/2021

Abstract

Introduction

Dehydration is a major problem in the older population with traumatic hip fractures (THF). A preoperative hemodynamic preconditioning (PHP) protocol may help in achieving hemodynamic stability to ensure adequate perfusion and oxygenation using only clinical parameters to assess cardiovascular performance.

Materials and methods

A single-centre retrospective study in geriatric trauma patients was conducted in a Level 1 Trauma Centre in Switzerland. Patients over the age of 70 with THFs and with Portsmouth Physiological and Operative Severity Score for the enUmeration of Mortality (P-POSSUM) scores ≥ 5% who underwent surgical treatment between February 2015 and October 2017 were included. It was hypothesized that patients whose hemodynamic stability was optimised before surgery would have fewer complications and reduced mortality postoperatively. Primary outcomes were complications and mortality. Secondary outcomes were hospital length of stay (HLOS) and place of discharge.

Results

100 patients were included in the PHP group and 79 patients were included in the non-PHP group. The median age was 86.5 (82–90) in the PHP group and 86 (82–90) in the non-PHP group. Patients who had been treated according to the PHP protocol showed a significant reduction in mortality at 30 days (p = 0.02). The PHP group showed an 8.1 and 3.5% reduced mortality at 90 days and at 1 year, respectively. The PHP group showed an 11.7% reduction of patients with complicated courses. No significant differences were seen in HLOS and discharge disposition.

Conclusions

The PHP group showed a significant reduction in short-term mortality, a reduction in long-term mortality, and a reduction in the number of patients with complicated courses. The PHP protocol is a safe, strictly regulated, non-invasive fluid resuscitation protocol for the optimization of geriatric patients with a THF that requires minimal effort.

Level of evidence

Level III, therapeutic

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Title: Does preoperative hemodynamic preconditioning improve morbidity and mortality after traumatic hip fracture in geriatric patients? A retrospective cohort study
Authors: J. Q. Kusen
P. C. R. van der Vet
F. J. G. Wijdicks
B. C. Link
B. Poblete
D. van der Velde
R. Babst
F. J. P. Beeres
Publication date: 01-09-2021
Publisher: Springer Berlin Heidelberg
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 9/2021
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-020-03601-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Does preoperative hemodynamic preconditioning improve morbidity and mortality after traumatic hip fracture in geriatric patients? A retrospective cohort study

Abstract

Introduction

Materials and methods

Results

Conclusions

Level of evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Materials and methods

Results

Conclusions

Level of evidence

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