Does preoperative hemodynamic preconditioning improve morbidity and mortality after traumatic hip fracture in geriatric patients? A retrospective cohort study
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 cardiova...
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| Veröffentlicht in: | Archives of orthopaedic and trauma surgery 2021-09, Vol.141 (9), p.1491-1497 |
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| creator | Kusen, J. Q. van der Vet, P. C. R. Wijdicks, F. J. G. Link, B. C. Poblete, B. van der Velde, D. Babst, R. Beeres, F. J. P. |
| description | 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 |
| doi_str_mv | 10.1007/s00402-020-03601-5 |
| format | Article |
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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</description><identifier>ISSN: 0936-8051</identifier><identifier>EISSN: 1434-3916</identifier><identifier>DOI: 10.1007/s00402-020-03601-5</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Blood ; Cohort analysis ; Electrocardiography ; Fractures ; Geriatrics ; Hospitals ; Length of stay ; Medicine ; Medicine & Public Health ; Mortality ; Orthopedics ; Patients ; Physiology ; Surgery ; Surgical outcomes ; Trauma ; Trauma Surgery</subject><ispartof>Archives of orthopaedic and trauma surgery, 2021-09, Vol.141 (9), p.1491-1497</ispartof><rights>Springer-Verlag GmbH Germany, part of Springer Nature 2020</rights><rights>Springer-Verlag GmbH Germany, part of Springer Nature 2020.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c352t-3119f16d03894e69f6f8149e47d6804b05e241c9792120ed23c973cc05994ad13</citedby><cites>FETCH-LOGICAL-c352t-3119f16d03894e69f6f8149e47d6804b05e241c9792120ed23c973cc05994ad13</cites><orcidid>0000-0003-1543-4840</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00402-020-03601-5$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00402-020-03601-5$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27922,27923,41486,42555,51317</link.rule.ids></links><search><creatorcontrib>Kusen, J. Q.</creatorcontrib><creatorcontrib>van der Vet, P. C. R.</creatorcontrib><creatorcontrib>Wijdicks, F. J. G.</creatorcontrib><creatorcontrib>Link, B. C.</creatorcontrib><creatorcontrib>Poblete, B.</creatorcontrib><creatorcontrib>van der Velde, D.</creatorcontrib><creatorcontrib>Babst, R.</creatorcontrib><creatorcontrib>Beeres, F. J. P.</creatorcontrib><title>Does preoperative hemodynamic preconditioning improve morbidity and mortality after traumatic hip fracture in geriatric patients? A retrospective cohort study</title><title>Archives of orthopaedic and trauma surgery</title><addtitle>Arch Orthop Trauma Surg</addtitle><description>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</description><subject>Blood</subject><subject>Cohort analysis</subject><subject>Electrocardiography</subject><subject>Fractures</subject><subject>Geriatrics</subject><subject>Hospitals</subject><subject>Length of stay</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Mortality</subject><subject>Orthopedics</subject><subject>Patients</subject><subject>Physiology</subject><subject>Surgery</subject><subject>Surgical outcomes</subject><subject>Trauma</subject><subject>Trauma Surgery</subject><issn>0936-8051</issn><issn>1434-3916</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kU1r3DAQhkVpoNtN_kBOglx6cTP6sNc6hZB-wkIvyVlo5XFWwZYcSS7sn8lvjbwbKPSQkzSad57RzEvIJYOvDGBznQAk8Ao4VCAaYFX9gayYFLISijUfyQqUaKoWavaJfE7pCYDxVsGKvHwLmOgUMUwYTXZ_ke5xDN3Bm9HZJWGD71x2wTv_SN04xVA0Y4g7V54P1PhuibIZjlGfMdIczTwWmKV7N9E-GpvniNR5-ojRmRwXcsmjz-mG3tKIOYY0oT32t2FfeDTluTuck7PeDAkv3s41efjx_f7uV7X98_P33e22sqLmuRKMqZ41HYhWSWxU3_QtkwrlpmtakDuokUtm1UZxxgE7LspdWAu1UtJ0TKzJlxO3jPc8Y8p6dMniMBiPYU6aS9motlVlpWty9Z_0KczRl99pXhdeLaRcgPyksmWyFLHXU3SjiQfNQC-W6ZNlulimj5bpuhSJU1EqYl929Q_9TtUrXqmcew</recordid><startdate>20210901</startdate><enddate>20210901</enddate><creator>Kusen, J. Q.</creator><creator>van der Vet, P. C. R.</creator><creator>Wijdicks, F. J. G.</creator><creator>Link, B. C.</creator><creator>Poblete, B.</creator><creator>van der Velde, D.</creator><creator>Babst, R.</creator><creator>Beeres, F. J. P.</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-1543-4840</orcidid></search><sort><creationdate>20210901</creationdate><title>Does preoperative hemodynamic preconditioning improve morbidity and mortality after traumatic hip fracture in geriatric patients? A retrospective cohort study</title><author>Kusen, J. Q. ; van der Vet, P. C. R. ; Wijdicks, F. J. G. ; Link, B. C. ; Poblete, B. ; van der Velde, D. ; Babst, R. ; Beeres, F. J. P.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c352t-3119f16d03894e69f6f8149e47d6804b05e241c9792120ed23c973cc05994ad13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Blood</topic><topic>Cohort analysis</topic><topic>Electrocardiography</topic><topic>Fractures</topic><topic>Geriatrics</topic><topic>Hospitals</topic><topic>Length of stay</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Mortality</topic><topic>Orthopedics</topic><topic>Patients</topic><topic>Physiology</topic><topic>Surgery</topic><topic>Surgical outcomes</topic><topic>Trauma</topic><topic>Trauma Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kusen, J. Q.</creatorcontrib><creatorcontrib>van der Vet, P. C. R.</creatorcontrib><creatorcontrib>Wijdicks, F. J. G.</creatorcontrib><creatorcontrib>Link, B. C.</creatorcontrib><creatorcontrib>Poblete, B.</creatorcontrib><creatorcontrib>van der Velde, D.</creatorcontrib><creatorcontrib>Babst, R.</creatorcontrib><creatorcontrib>Beeres, F. J. P.</creatorcontrib><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Archives of orthopaedic and trauma surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kusen, J. Q.</au><au>van der Vet, P. C. R.</au><au>Wijdicks, F. J. G.</au><au>Link, B. C.</au><au>Poblete, B.</au><au>van der Velde, D.</au><au>Babst, R.</au><au>Beeres, F. J. P.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Does preoperative hemodynamic preconditioning improve morbidity and mortality after traumatic hip fracture in geriatric patients? A retrospective cohort study</atitle><jtitle>Archives of orthopaedic and trauma surgery</jtitle><stitle>Arch Orthop Trauma Surg</stitle><date>2021-09-01</date><risdate>2021</risdate><volume>141</volume><issue>9</issue><spage>1491</spage><epage>1497</epage><pages>1491-1497</pages><issn>0936-8051</issn><eissn>1434-3916</eissn><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</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><doi>10.1007/s00402-020-03601-5</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0003-1543-4840</orcidid></addata></record> |
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| source | SpringerLink Journals - AutoHoldings |
| subjects | Blood Cohort analysis Electrocardiography Fractures Geriatrics Hospitals Length of stay Medicine Medicine & Public Health Mortality Orthopedics Patients Physiology Surgery Surgical outcomes Trauma Trauma Surgery |
| title | Does preoperative hemodynamic preconditioning improve morbidity and mortality after traumatic hip fracture in geriatric patients? A retrospective cohort study |
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