Inflammatory and nutritional markers predict the risk of post-operative delirium in elderly patients following total hip arthroplasty
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SUBMITTER: Hu W
PROVIDER: S-EPMC10651730 | biostudies-literature | 2023 Jan
REPOSITORIES: biostudies-literature
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Project description:Primary total hip arthroplasty (THA) is among the most common surgical procedures and known to potentially cause significant blood loss. In total, 74,814 patients from the National Surgical Quality Improvement Project Database were studied. Complications were divided into post-operative and non-operative complications. Pre-operative transfusion in THA patients was found to be an independent predictor of infection (OR: 5.41), pneumonia (OR: 2.66), failure to wean (OR: 13.84), urinary tract infection (OR: 3.42), cardiac arrest (OR: 5.83), and transfusion post-operatively (OR: 5.94). Future medical decisions in primary THA cases should entail a careful risk-benefit and close monitoring in order to prevent complications.
| S-EPMC6411999 | biostudies-literature
Project description:BACKGROUND:Postoperative stroke is a rare but potentially devastating complication following total hip arthroplasty (THA) and total knee arthroplasty (TKA). The purpose of the current study was to determine the incidence, independent risk factors, and timing of stroke following THA and TKA utilizing the National Surgical Quality Improvement (NSQIP) database. METHODS:Patients who underwent elective primary THA and TKA were identified in the 2005-2016 NSQIP database. Thirty-day postoperative strokes were identified, timing was characterized, and an incidence curve was created. Multivariate analyses determined the independent predictors of these strokes. RESULTS:Of 333,117 patients identified, 286 (0.09%) experienced a stroke. Given that THA vs TKA was not a univariate predictor of stroke, the two procedures were considered together. The majority (65%) of strokes occurred before discharge. Of the strokes observed, 25% occurred by postoperative day one, 50% by postoperative day two, and 75% by postoperative day nine. Independent risk factors for postoperative stroke were: age (60-69 years old odds ratio [OR] = 4.2; 70-79 years old OR = 8.1; ?80 years old OR = 16.1), higher American Society of Anesthesiologists (ASA) score (ASA?3 OR = 1.7), and smoking [OR = 1.6). CONCLUSION:The incidence of stroke after THA/TKA was low at 0.09%, with the majority occurring prior to discharge and half occurring by postoperative day two. Patients who were older, sicker, or who were smokers were at greater risk of postoperative stroke. These findings can be used to council patients and to optimize patient care. LEVEL OF EVIDENCE:Level III, Retrospective comparative study.
| S-EPMC7498016 | biostudies-literature
Project description:BackgroundPeriprosthetic fractures are a devastating complication of total hip arthroplasty (THA) and are associated with significantly higher mortality rates in the postoperative period. Given the strain that periprosthetic fractures place on the patient as well as the healthcare system, identifying and optimizing medical comorbidities is essential in reducing complications and improving outcomes.MethodsAll THA with primary indications of osteoarthritis from 2007 to 2020 were queried from the National Surgical Quality Improvement Program database. Demographic data, preoperative laboratory values, medical comorbidities, hospital course, and acute complications were collected and compared between patients with and without readmission for a periprosthetic fracture. A multivariate logistic regression analysis was performed to determine associated independent risk factors for periprosthetic fractures after index THA.ResultsThe analysis included 275,107 patients, of which 2539 patients were readmitted for periprosthetic fractures. Patients with postoperative fractures were more likely to be older (>65 years), females, BMI >40, and increased medical comorbidities. Preoperative hypoalbuminemia, hyponatremia, and abnormal estimated glomerular filtration rates were independent risk factors for sustaining a periprosthetic fracture and readmission within 30 days. Modifiable patient-related factors of concurrent smoking and chronic steroid use at the time of index THA were also independent risk factors for periprosthetic fractures. Inpatient metrics of longer length of stay, operative time, and discharge to rehab predicted postarthroplasty fracture risk. Readmitted fracture patients subsequently had increased risks of developing a surgical site infection, urinary tract infection, and requiring blood transfusions.ConclusionsPatients with hypoalbuminemia, hyponatremia, and abnormal estimated glomerular filtration rate are at increased risk for sustaining periprosthetic fractures after THA. Preoperative optimization with close monitoring of metabolic markers and modifiable risk factors may help not only prevent acute periprosthetic fractures but also associated infection and bleeding risk with fracture readmission.
| S-EPMC9860454 | biostudies-literature
Project description:Currently, orthopedic surgeons mainly use the inter-teardrop line (IT-line) as the transverse mechanical axis of the pelvis (TAP) for postoperative evaluation of total hip arthroplasty (THA). However, the teardrop is often unclear in the pelvis anteroposterior (AP) radiographs, which makes postoperative evaluation of THA difficult. In this study, we attempted to identify other clear and accurate axes for postoperative evaluation of THA. We calculated the mean and standard deviation of these angles and tested the significance of these angles using t-tests. The inter-teardrops line (IT line) and the upper rim of the obturator foramen (UOF) had smaller angles with the IFH line. The bi-ischial line (BI line) was relatively inaccurate in measurements. We recommend using the IT line as the TAP when the lower boundary of the teardrops is clear and the shapes of the teardrops on both sides of the pelvis are symmetrical. When there is no deformation of the obturator foramen on pelvic AP radiographs, the UOF is also a good choice for the TAP. We do not recommend the BI line as the TAP.
| S-EPMC10216800 | biostudies-literature
Project description:BackgroundTotal hip or knee arthroplasty is an elective procedure that is usually accompanied by substantial blood loss, which may lead to acute anemia. As a result, almost half of total joint arthroplasty patients receive allogeneic blood transfusions (ABT). Many studies have shown that post-operative auto-transfusion (PAT) significantly reduces the need for ABT, but other studies have questioned the efficacy of this method.MethodsThe protocol for this trial and supporting CONSORT checklist are available as supporting information; see Checklist S1. To evaluate the efficacy of PAT, we conducted a Cochrane systematic review that combined all available data from randomized controlled trials. Data from the six included trials were pooled for analysis. We then calculated relative risks with 95% confidence intervals (CIs) for dichotomous outcomes and mean differences with 95% CIs for continuous outcomes.Findings and conclusionTo our knowledge, this is the first meta-analysis to compare the clinical results between PAT and a control in joint replacement patients. This meta-analysis has proven that the use of a PAT reinfusion system reduced significantly the demand for ABT, the number of patients who require ABT and the cost of hospitalization after total knee and hip arthroplasty. This study, together with other previously published data, suggests that PAT drains are beneficial. Larger, sufficiently powered studies are necessary to evaluate the presumed reduction in the incidence of infection as well as DVT after joint arthroplasty with the use of PAT.
| S-EPMC3555861 | biostudies-literature
Project description:BackgroundPostoperative delirium (POD) is widely reported as a common postoperative complication following total joint arthroplasty (TJA) of the hip and knee in elderly patients, leading to many adverse effects. We sought to investigate predictors of delirium after TJA.MethodsPubMed, EMBASE, Cochrane Library and Web of Science were searched up to 2020 for studies examining POD following TJA in elderly patients. Pooled odds ratio (OR) and mean difference (MD) of those who experienced delirium compared to those who did not were calculated for each variable. The Newcastle-Ottawa Scale (NOS) was used for the study quality evaluation.ResultsFifteen studies with 31 potential factors were included. In the primary analysis, 9 factors were associated with POD, comprising advanced age (MD 3.81; 95% confidence interval (CI) 1.80-5.83), dementia (OR 24.85; 95% CI 7.26-85.02), hypertension (OR 2.26; 95% CI 1.31-3.89), diabetes (OR 2.02; 95% CI 1.15-3.55), stroke (OR 14.61; 95% CI 5.26-40.55), psychiatric illness (OR 2.72; 95% CI 1.45-5.08), use of sedative-hypnotics (OR 6.42; 95% CI 2.53-16.27), lower preoperative levels of hemoglobin (MD - 0.56; 95% CI - 0.89-- 0.22), and lower preoperative mini-mental state examination score (MD - 0.40; 95% CI - 0.69-- 0.12). Twelve studies were included in the systematic review, of which 24 factors were additionally correlated with POD using single studies.ConclusionsStrategies and interventions should be implemented for the elderly patients receiving TJA surgeries with potential predictors identified in this meta-analysis.
| S-EPMC8588632 | biostudies-literature
Project description:Digital templating with external calibration markers is the standard method for planning total hip arthroplasty. We determined the geometrical basis of the magnification effect, compared magnification with external and internal calibration markers, and examined the influence on magnification of the position of the calibration markers, patient weight, and body mass index (BMI). A formula was derived to calculate magnification with internal and external calibration markers, informed by 100 digital radiographs of the pelvis. Intraclass correlations between the measured and calculated values and the strength of relationships between magnification, position and distance of calibration markers and height, weight, and BMI were sought. There was a weak correlation between magnification of internal and external calibration markers (r = 0.297-0.361; p < 0.01). Intraclass correlations were 0.882-1.000 (p = 0.000) for all parameters. There were also weak correlations between magnification of internal and external calibration markers and weight and BMI (r = 0.420, p = 0.000; r = 0.428, p = 0.000, respectively). The correlation between external and internal calibration markers was poor, indicating the need for more accurate calibration methods. While weight and BMI weakly correlated with the magnification of markers, future studies should examine this phenomenon in more detail.
| S-EPMC4500467 | biostudies-literature
Project description:ObjectivesTo determine the effectiveness of balance exercises in the acute post-operative phase following total hip arthroplasty or total knee arthroplasty.MethodsPatients who had total hip arthroplasty (n = 30) or total knee arthroplasty (n = 33) were seen in their residence 1-2 times per week for 5 weeks. At the first post-operative home visit, patients were randomly assigned to either typical (TE, n = 33) or typical plus balance (TE + B, n = 30) exercise groups. The TE group completed seven typical surgery-specific joint range-of-motion and muscle strengthening exercises, while the TE + B group completed the typical exercises plus three balance exercises. Patients were assessed before and 5 weeks after administering the rehabilitation program using four outcome measures: (1) the Berg Balance Scale, (2) the Timed Up and Go test, (3) the Western Ontario McMaster Universities Osteoarthritis Index, and (4) the Activities-specific Balance Confidence Scale.ResultsPost-intervention scores for all four outcome measures were significantly improved (p < 0.01) over baseline scores. Patients who participated in the TE + B group demonstrated significantly greater improvement on the Berg Balance Scale and the Timed Up and Go tests (p < 0.01).ConclusionBalance exercises added to a typical rehabilitation program resulted in significantly greater improvements in balance and functional mobility compared to typical exercises alone.
| S-EPMC4679229 | biostudies-literature
Project description:BackgroundPost-operative rehabilitation after posterior-approach total hip arthroplasty (P-THA) includes the use of standard hip precautions, defined as no hip flexion beyond 90°, hip adduction, or hip internal rotation for 6 to 12 weeks after surgery (sometimes for life). Since they were first implemented in the 1970s, subsequent advances may have made standard hip precautions no longer necessary, although little evidence supports that hypothesis. A modified set of precautions, a "pose avoidance protocol," could be effective in enhancing recovery, but its effectiveness on early dislocation and post-surgical outcomes is not known.Questions/purposesWe sought to determine the functional recovery of patients on a pose avoidance protocol after P-THA according to levels of pain and patient satisfaction, rates of dislocation, the use of assistive devices, and a return to driving.MethodsWe conducted a retrospective, descriptive study of data from a consecutive case series of 164 patients treated by a single surgeon between January 2014 and December 2015. Patients who had undergone a primary uncemented P-THA were prescribed a pose avoidance protocol and followed for a minimum of 6 weeks. Exclusion criteria were patients with congenital hip dysplasia, revision THA, femoral neck fracture, rheumatoid arthritis, or neuromuscular disease. Changes to the rehabilitation protocol included elimination of the requirements to use elevated chairs, raised toilet seats, and abduction pillows for sleeping. Patients could resume driving at 2 and 3 weeks for left and right P-THA, respectively. The only motion restriction was avoiding the combination of hip flexion past 90°, hip adduction, and hip internal rotation. Patients could perform all other movements and to bear weight and stop using walking aids as tolerated. Patients completed a biweekly questionnaire to assess their functional recovery, opioid use, and pain levels.ResultsAt 2 weeks after surgery, 80% of patients reported no pain, 86% did not require walking aids, and 92% were satisfied with their recovery. At 6 weeks after surgery, 89% of patients reported no pain. Patients returned to driving at a mean of 2.7 weeks after surgery. No patients had experienced a dislocation at 6 weeks of follow-up.ConclusionA pose avoidance rehabilitation protocol in this P-THA population was found to be safe and was associated with accelerated functional recovery and high patient satisfaction without increased risk of early post-operative dislocation.
| S-EPMC6778163 | biostudies-literature
Project description:BackgroundThe postoperative delirium is a common yet serious complication in elderly patients with hip fracture. We aimed to evaluate the potential risk factors of delirium in patients with hip fracture, to provide reliable evidence to the clinical management of hip fracture.MethodsThis study was a retrospective design. Elderly patients who underwent hip fracture surgery in our hospital from June 1, 2019 to December 30, 2020 were selected. The characteristics and treatment data of delirium and no delirium patients were collected and compared. Multivariate logistic regression analysis was performed to analyze the influencing factors affecting postoperative delirium in elderly patients with hip fracture.ResultsA total of 245 patients with hip fracture were included, the incidence of postoperative delirium in patients with hip fracture was 13.06%. There were significant differences in the age, BMI, history of delirium, estimated blood loss and duration of surgery (all p < 0.05). There were significant differences in the albumin and TSH between delirium and no delirium group (all p < 0.05), Logistics analyses indicated that age ≥ 75 years (OR 3.112, 95% CI 1.527-5.742), BMI ≥ 24 kg/m2 (OR 2.127, 95% CI 1.144-3.598), history of delirium (OR 1.754, 95% CI 1.173-2.347), estimated blood loss ≥ 400 mL (OR 1.698, 95% CI 1.427-1.946), duration of surgery ≥ 120 min (OR 2.138, 95% CI 1.126-3.085), preoperative albumin ≤ 40 g/L (OR 1.845, 95% CI 1.102-2.835) and TSH ≤ 2 mU/L (OR 2.226, 95% CI 1.329-4.011) were the independent risk factors of postoperative delirium in patients with hip fracture(all p < 0.05).ConclusionsPostoperative delirium is very common in elderly patients with hip fracture, and it is associated with many risk factors, clinical preventions targeted on those risk factors are needed to reduce the postoperative delirium.
| S-EPMC8917680 | biostudies-literature