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Proximal Femoral Fracture (proximal + femoral_fracture)
Selected AbstractsProximal femoral fracture: an acute emergency?ANAESTHESIA, Issue 6 2010S. J. McAfee No abstract is available for this article. [source] Anaesthesia for proximal femoral fracture in the UK: first report from the NHS Hip Fracture Anaesthesia Network,ANAESTHESIA, Issue 3 2010S. M. White Summary The aim of this audit was to investigate process, personnel and anaesthetic factors in relation to mortality among patients with proximal femoral fractures. A questionnaire was used to record standardised data about 1195 patients with proximal femoral fracture admitted to 22 hospitals contributing to the Hip Fracture Anaesthesia Network over a 2-month winter period. Patients were demographically similar between hospitals (mean age 81 years, 73% female, median ASA grade 3). However, there was wide variation in time from admission to operation (24,108 h) and 30-day postoperative mortality (2,25%). Fifty percent of hospitals had a mean admission to operation time < 48 h. Forty-two percent of operations were delayed: 51% for organisational; 44% for medical; and 4% for ,anaesthetic' reasons. Regional anaesthesia was administered to 49% of patients (by hospital, range = 0,82%), 51% received general anaesthesia and 19% of patients received peripheral nerve blockade. Consultants administered 61% of anaesthetics (17,100%). Wide national variations in current management of patients sustaining proximal femoral fracture reflect a lack of research evidence on which to base best practice guidance. Collaborative audits such as this provide a robust method of collecting such evidence. [source] An analysis of renal dysfunction in 1511 patients with fractured neck of femur: the implications for peri-operative analgesiaANAESTHESIA, Issue 10 2009S. M. White Summary Following two deaths from respiratory failure secondary to opioid toxicity in patients admitted for surgical repair of fractured neck of femur, we retrospectively studied the serum urea and electrolyte concentrations of 1511 consecutive patients requiring surgery for proximal femoral fracture, and calculated their glomerular filtration rate. Five hundred and forty-five (36.1%) patients had renal dysfunction on admission (glomerular filtration rate < 60 ml.min,1.1.73 m,2); 435 (28.8%) had grade 3 chronic kidney disease (moderate; glomerular filtration rate 30,59 ml.min,1.1.73 m,2), 82 (5.4%) had grade 4 disease (severe; glomerular filtration rate 15,29 ml.min,1.1.73 m,2) and 28 (1.9%) had grade 5 (renal failure; glomerular filtration rate < 15 ml min,1.1.73 m,2). The 30-day mortality for patients with renal dysfunction (62/536; 11.6%) was significantly greater (p = 0.004) than for patients with normal renal function (68/958; 7.1%), although median (IQR [range]) postoperative lengths of stay were similar 15 (10,22 [1,125]) vs 14 (9,22 [1,120]) days respectively; p = 0.06). Renal impairment is common in patients admitted for fixation of fractured neck of femur, who are consequently at risk of opioid toxicity. [source] A prospective study of the effect of nursing home residency on mortality following hip fractureANZ JOURNAL OF SURGERY, Issue 6 2010Ian A. Harris Abstract Background:, The strength of nursing home residence as a prognostic indicator of outcome following hip fracture has not previously been examined in Australia. The aim of the study was to examine the influence of nursing home residency on mortality after sustaining an acute hip fracture. Methods:, A prospective study of all adults aged 65 years and over presenting to a single tertiary referral hospital for management of a proximal femoral fracture between July 2003 and September 2006. Residential status was obtained at admission. Patients were followed up to September 2007 (minimum 12 months). Relative risk values for mortality were calculated comparing nursing home residents with non-nursing home residents. Survival analysis was performed. Results:, Relative risk of death was higher in nursing home patients compared with non-nursing home patients. The difference was greater in the immediate period (30 days) post-injury (relative risk 1.9, 95% confidence interval 1.0,3.6, P= 0.04) than after 12 months (relative risk 1.5, 95% confidence interval 1.2,1.8, P= 0.001). Survival analysis showed that 25% of patients in the nursing home group died by 96 days post-injury, compared with 435 days in the non-nursing home group. Conclusions:, Nursing home residence confers an increased risk of death following hip fracture; this difference is greater in the immediate post-injury period. The relative risk of death decreases over time to equal previously reported comparative mortality rates between nursing home residents and community dwellers without hip fracture. [source] | ||||||||||