Predictors of mortality and length of stay after hip fractures – A multicenter retrospective analysis

BackgroundThe ubiquity of hip fractures pose a substantial burden on public health services worldwide. There is widespread geographical variation in mortality rates and length of stay after hip fractures. The current study investigates both the predictors of; (1) one-year mortality and (2) length of hospital stay (LOS) in adults aged 60 years or older. We aim to identify the risk factors and quantify the extent of influence they have on both outcomes.MethodologyA retrospective multi-center cohort study identified consecutively documented hip fractures between January 2013 and September 2018. A multivariate regression analysis of 603 patients was performed to determine independent factors affecting mortality and total LOS.ResultsThe study sample included 603 patients with a total one-year mortality rate of 20.6% (n = 124). Predictors of mortality included; longer LOS, increasing age, inability to return to baseline mobility and comorbid burden. The mean overall LOS was 15.1 days, and 22.6 days in the mortality group. Predictors of increased LOS included; previous hip fractures, comorbid burden; diabetic, cerebrovascular disease and smokers. Return to baseline mobility status was associated with reduced LOS.ConclusionPatients with a longer length of stay, inability to return to baseline mobility status, higher ASA scores, previous hip fractures and longer time to surgery had a higher mortality rate. Determinants of a longer LOS include; increased time to surgery, impeded postoperative mobility status, fixation rather than joint replacement and comorbid burden. A multifaceted approach to preoperative optimization and postoperative recovery is crucial in order to address all possible modifiable factors.     

A prospective randomized comparison among SWL,PCNL and RIRS for lower calyceal stones less than 2 cm: a multicenter experience

Purpose

To prospectively evaluate the efficacy and safety of RIRS, SWL and PCNL for lower calyceal stones sized 1–2 cm.

Materials and methods

Patients with a single lower calyceal stone with an evidence of a CT diameter between 1 and 2 cm were enrolled in this multicenter, randomized, unblinded, clinical trial study. Patients were randomized into three groups: group A: SWL (194 pts); group B: RIRS (207 pts); group C: PCNL (181 pts). Patients were evaluated with KUB radiography (US for uric acid stones) at day 10 and a CT scan after 3 months. The CONSORT 2010 statement was adhered to where possible. The collected data were analyzed.

Results

The mean stone size was 13.78 mm in group A, 14.82 mm in group B and 15.23 mm in group C (p = 0.34). Group C compared to group B showed longer operative time [72.3 vs. 55.8 min (p = 0.082)], fluoroscopic time [175.6 vs. 31.8 min (p = 0.004)] and hospital stay [3.7 vs. 1.3 days (p = 0.039)]. The overall stone-free rate (SFR) was 61.8% for group A, 82.1% for group B and 87.3% for group C. The re-treatment rate was significantly higher in group A compared to the other two groups, 61.3% (p < 0.05). The auxiliary procedure rate was comparable for groups A and B and lower for group C (p < 0.05). The complication rate was 6.7, 14.5 and 19.3% for groups A, B and C, respectively.

Conclusions

RIRS and PCNL were more effective than SWL to obtain a better SFR and less auxiliary and re-treatment rate in single lower calyceal stone with a CT diameter between 1 and 2 cm. RIRS compared to PCNL offers the best outcome in terms of procedure length, radiation exposure and hospital stay.ISRCTN 55546280.

     

A prospective,multicenter analysis of pseudocapsule characteristics: Do all stages of renal cell carcinoma have complete pseudocapsules?

Objectives

To assess the characteristics of pseudocapsule (PC) in localized renal cell carcinoma (RCC) by analyzing the rates of completeness of PC and pseudocapsular invasion and clinical and pathological risk factors of it.

Catheter distances and balloon inflation volumes for the ER-REBOA™ catheter: A prospective analysis

IntroductionResuscitative endovascular balloon occlusion of the aorta (REBOA) is an adjunct used to temporize uncontrolled abdominopelvic hemorrhage. No published clinical data exist that describe average catheter lengths or balloon fill volumes necessary to occlude the aorta.MethodsA prospective, single-institution registry was queried for patients who underwent placement of a Prytime ER-REBOA™ catheter. Demographic, catheter, hemodynamic, and morphometric data were measured. Linear regression analyses were performed to identify variables associated with insertion distances and balloon volumes.Results45 patients underwent supraceliac REBOA: median catheter insertion distance 45 cm [IQR 42–46], balloon inflation volume 14 mL [IQR 8–19], systolic blood pressure (SBP) augmentation 50 mmHg [IQR 35–55]. 14 patients underwent infrarenal deployment: median catheter insertion distance 28.5 cm [IQR 26.5–32.5], balloon volume 10 mL [IQR 5–15]; SBP augmentation 55 mmHg [IQR 40–65]. Patient body metrics were not associated with catheter length or balloon volume.ConclusionA wide range of catheter insertion distances and balloon fill volumes were necessary for correct REBOA positioning and occlusion. No single patient metric accurately correlated with catheter distance or balloon volume.Level of evidenceLevel IV, Prognostic.     

A multicenter observational cohort study of 24 h and 30 day in-hospital mortality of pediatric and adult trauma patients — An Indian urban tertiary care perspective

Background/PurposeIndia with its evolving trauma system needs multicenter studies on trauma outcomes to help determine the need for planning and structuring care better and to bridge the gap between the burden of disease and research. Therefore here we studied 24 h and 30 day mortality in adult and pediatric trauma population presenting to urban tertiary care hospitals.MethodologyData from multicenter observational cohort study conducted from July 2013 to December 2015, Towards improved trauma care outcomes in India (TITCO) were used.Main findings3381 pediatric and 12,666 adult trauma patients. Unadjusted analyses of mortality were significantly less in pediatric compared to adult group within 24 h (OR 0.513, 99% CI 0.4–0.658, p < 0.001) and 30 days (OR 0.442, 99% CI 0.383–0.511, p < 0.001). In adjusted analyses pediatric group did not have significantly lower odds of 24-h mortality (OR 0.778, 99% CI 0.106–5.717, P = 0.746). At 30 days, pediatric group had 89% lower odds of death compared to adults (OR 0.11, 99% CI 0.017–0.0714, p = 0.002).ConclusionChildren had mechanisms of injury different from adults leading to less severe injuries than adults. Children are more likely than adults to survive until 30 days after admission for trauma in urban India.Level of evidenceLevel II.     

Impact of schizophrenia and related disorders on mortality from breast cancer: A population-based cohort study in Denmark, 1995–2011

ObjectivesTo investigate overall and breast cancer-specific mortality in early-stage breast cancer patients with and without schizophrenia or related disorders.MethodsWe used Danish national registers to identify all women with no prior history of cancer or organic mental disorders, who were diagnosed with early-stage breast cancer 1995–2011. Logistic regression models were used to calculate the odds ratios (ORs) for not being allocated to guideline treatment. Cox regression models were used to compute hazard ratios (HRs) for overall and breast cancer-specific deaths among women allocated or not allocated to guideline treatment.ResultsWe identified 56,152 women with early-stage breast cancer diagnosed in 1995–2011, of whom 499 women also had been diagnosed with schizophrenia or related disorders. The likelihood of women with schizophrenia or related disorders for not being allocated to guideline treatment was increased (adjusted OR, 1.50; 95% confidence interval (CI), 1.15–1.94). The adjusted HR for all-cause mortality was 1.55; 95% CI, 1.32–1.82 and 1.12 (95% CI, 0.98–1.50) for breast cancer-specific mortality; women allocated to guideline treatment had an adjusted HR for breast cancer-specific death of 1.42 (95% CI, 1.11–1.82). The adjusted HR for death due to unnatural causes was 3.67 (95% CI, 1.80–7.35).ConclusionThe survival of women with schizophrenia or related disorders after breast cancer is significantly worse than that of women without these disorders. These patients are less likely to be allocated to guideline treatment, and, among those who are, mortality from both breast cancer and other causes is increased.     

Determinants of “return to work in good health” among workers with back pain who consult in primary care settings: a 2-year prospective study

Many factors have been linked to return to work after a back pain episode, but our understanding of this phenomenon is limited and cross-sectional dichotomous indices of return to work are not valid measures of this construct. To describe the course of "return to work in good health" (RWGH--a composite index of back pain outcome) among workers who consulted in primary care settings for back pain and identify its determinants, a 2-year prospective study was conducted. Subjects (n = 1,007, 68.4%) were workers who consulted in primary care settings of the Quebec City area for a nonspecific back pain. They completed five telephone interviews over 2 years (follow-up = 86%). Analyses linking baseline variables with 2-year outcome were conducted with polytomous logistic regression. The proportion of "success" in RWGH increased from 18% at 6 weeks to 57% at 2 years. In women, persistent pain, pain radiating to extremities, increasing job seniority, not having a unionized job, feeling that the physician did listen carefully and increasing fear-avoidance beliefs towards work and activity were determinants of "failure" in RWGH. In men, decreasing age, cigarette smoking, poor self-reported health status, pain in the thoracic area, previous back surgeries, a non-compensated injury, high pain levels, belief that job is below qualifications, likelihood of losing job, job status, satisfaction with health services and fear-avoidance beliefs towards work were all significant. RWGH among workers with back pain receives multiple influences, especially among men. In both genders, however, fear-avoidance beliefs about work are associated with failure and high self-efficacy is associated with success.