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Utility of Geriatric Assessment in the Projection of Early Mortality Following Hip Fracture in the Elderly Patients

Hip fractures result in significant morbidity and mortality in elders. Indicators of frailty are associated with poor outcomes. Commonly used frailty tools rely on motor skills that cannot be performed by this population. We determined the association between the Charlson Comorbidity Score (CCS), in...

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Autores principales: Palmer, Aunaly, Taitsman, Lisa A., Reed, May J., Nair, Bala G., Bentov, Itay
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6287303/
https://www.ncbi.nlm.nih.gov/pubmed/30546923
http://dx.doi.org/10.1177/2151459318813976
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author Palmer, Aunaly
Taitsman, Lisa A.
Reed, May J.
Nair, Bala G.
Bentov, Itay
author_facet Palmer, Aunaly
Taitsman, Lisa A.
Reed, May J.
Nair, Bala G.
Bentov, Itay
author_sort Palmer, Aunaly
collection PubMed
description Hip fractures result in significant morbidity and mortality in elders. Indicators of frailty are associated with poor outcomes. Commonly used frailty tools rely on motor skills that cannot be performed by this population. We determined the association between the Charlson Comorbidity Score (CCS), intraoperative hypotension (IOH), and a geriatric medicine consult index (GCI) with short-term mortality in hip fracture patients. A retrospective cohort study was conducted at a single institution over a 2-year period. Patients aged 65 years and older who sustained a hip fracture following a low-energy mechanism were identified using billing records and our orthopedic fracture registry. Medical records were reviewed to collect demographic data, fracture classification and operative records, calculation of CCS, intraoperative details including hypotension, and assessments recorded in the geriatric consult notes. The GCI was calculated using 30 dichotomous variables contained within the geriatric consult note. The index, ranging from 0 to 1, included markers for physical and cognitive function, as well as medications. A higher GCI score indicated more markers for frailty. One hundred eight patients met inclusion criteria. Sixty-four (59%) were females and the average age was 77.3 years. Thirty-five (32%) patients sustained femoral neck fractures, and 73 (68%) patients sustained inter-/pertrochanteric hip fractures. The 30-day mortality was 6%; the 90-day mortality was 13%. The mean GCI was 0.30 in the 30-day survivor group as compared to 0.52 in those who died. The mean GCI was 0.28 in patients who were alive at 90 days as compared to 0.46 in those who died. In contrast, the CCS and IOH were not associated with 30- or 90-day mortality. In our older hip fracture patients, an index calculated from information routinely obtained in the geriatric consult evaluation was associated with 30- and 90-day mortality, whereas the CCS and measures of IOH were not.
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spelling pubmed-62873032018-12-13 Utility of Geriatric Assessment in the Projection of Early Mortality Following Hip Fracture in the Elderly Patients Palmer, Aunaly Taitsman, Lisa A. Reed, May J. Nair, Bala G. Bentov, Itay Geriatr Orthop Surg Rehabil Article Hip fractures result in significant morbidity and mortality in elders. Indicators of frailty are associated with poor outcomes. Commonly used frailty tools rely on motor skills that cannot be performed by this population. We determined the association between the Charlson Comorbidity Score (CCS), intraoperative hypotension (IOH), and a geriatric medicine consult index (GCI) with short-term mortality in hip fracture patients. A retrospective cohort study was conducted at a single institution over a 2-year period. Patients aged 65 years and older who sustained a hip fracture following a low-energy mechanism were identified using billing records and our orthopedic fracture registry. Medical records were reviewed to collect demographic data, fracture classification and operative records, calculation of CCS, intraoperative details including hypotension, and assessments recorded in the geriatric consult notes. The GCI was calculated using 30 dichotomous variables contained within the geriatric consult note. The index, ranging from 0 to 1, included markers for physical and cognitive function, as well as medications. A higher GCI score indicated more markers for frailty. One hundred eight patients met inclusion criteria. Sixty-four (59%) were females and the average age was 77.3 years. Thirty-five (32%) patients sustained femoral neck fractures, and 73 (68%) patients sustained inter-/pertrochanteric hip fractures. The 30-day mortality was 6%; the 90-day mortality was 13%. The mean GCI was 0.30 in the 30-day survivor group as compared to 0.52 in those who died. The mean GCI was 0.28 in patients who were alive at 90 days as compared to 0.46 in those who died. In contrast, the CCS and IOH were not associated with 30- or 90-day mortality. In our older hip fracture patients, an index calculated from information routinely obtained in the geriatric consult evaluation was associated with 30- and 90-day mortality, whereas the CCS and measures of IOH were not. SAGE Publications 2018-12-03 /pmc/articles/PMC6287303/ /pubmed/30546923 http://dx.doi.org/10.1177/2151459318813976 Text en © The Author(s) 2018 http://creativecommons.org/licenses/by-nc/4.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Article
Palmer, Aunaly
Taitsman, Lisa A.
Reed, May J.
Nair, Bala G.
Bentov, Itay
Utility of Geriatric Assessment in the Projection of Early Mortality Following Hip Fracture in the Elderly Patients
title Utility of Geriatric Assessment in the Projection of Early Mortality Following Hip Fracture in the Elderly Patients
title_full Utility of Geriatric Assessment in the Projection of Early Mortality Following Hip Fracture in the Elderly Patients
title_fullStr Utility of Geriatric Assessment in the Projection of Early Mortality Following Hip Fracture in the Elderly Patients
title_full_unstemmed Utility of Geriatric Assessment in the Projection of Early Mortality Following Hip Fracture in the Elderly Patients
title_short Utility of Geriatric Assessment in the Projection of Early Mortality Following Hip Fracture in the Elderly Patients
title_sort utility of geriatric assessment in the projection of early mortality following hip fracture in the elderly patients
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6287303/
https://www.ncbi.nlm.nih.gov/pubmed/30546923
http://dx.doi.org/10.1177/2151459318813976
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