Session 2: Trauma I
Onsdag den 25. oktober
09:00 – 10:30
Lokale: Stockholm/Copenhagen
Chairmen: Lonnie Froberg og Henrik Palm
Eva Natalia Glassou, Nickolaj Kristensen, Bjarne Møller, Christian Erikstrup, Torben Bæk Hansen, Alma Becic Pedersen
University clinic of hand, hip and knee surgery, Department of Orthopedic Surgery, Regional Hospital West Jutland; Department of Clinical Epidemiology, Aarhus University Hospital; Department of Clinical Immunology, Aarhus University Hospital; Department of Clinical Immunology, Aarhus University Hospital; University clinic of hand, hip and knee surgery, Department of Orthopedic Surgery, Regional Hospital West Jutland; Department of Clinical Epidemiology, Aarhus University Hospital
Background: Despite advances in techniques of orthopedic surgery and improvement of pre- and postoperative treatment, hip fracture surgery is often associated with blood loss causing postoperative anemia.
Purpose / Aim of Study: Using red blood cell (RBC) transfusion as a surrogate for post-operative bleeding, the aim was to investigate if prescription drugs with anti-inflammatory properties such as NSAIDs, corticosteroids and statins increased the risk of RBC transfusion within the first week after hip fracture surgery in elderly patients in Denmark.
Materials and Methods: 56,420 surgery treated hip fracture patients aged 65 years or older registered in the Danish Multidisciplinary Hip Fracture Database in 2005-2013 were included. Information on treatment, transfusion, medication and comorbidities were collected using national administrative and clinical databases. Patients were categorized as non-users (no prescription ≤365 days prior to surgery), former users (one prescription ≤ 91-365 days) and current users (one prescription ≤ 90 days) of the three anti-inflammatory drugs. A log-binomial model was used to estimate relative risks (RRs) for RBC transfusion within 7 days of surgery and corresponding 95% confidence intervals (CIs). Adjustments were made for patient and surgery related factors.
Findings / Results: Current users of NSAIDs had an increased adjusted RR of transfusion (1.07, CI: 1.04 - 1.11) compared to non- users. There were no increase or decrease in RRs of transfusion for current users of corticosteroids and statins (0.97, CI: 0.93 - 1.01 and 1.03, CI: 1.00 - 1.05, respectively).
Conclusions: NSAID prescription within the last 90 days of a hip fracture surgery resulted in an increased risk of RBC transfusion. Thus, prescription of NSAID can be associated with an increased risk of post- operative bleeding in relation to hip fracture surgery.
University clinic of hand, hip and knee surgery, Department of Orthopedic Surgery, Regional Hospital West Jutland; Department of Clinical Epidemiology, Aarhus University Hospital; Department of Clinical Immunology, Aarhus University Hospital; Department of Clinical Immunology, Aarhus University Hospital; University clinic of hand, hip and knee surgery, Department of Orthopedic Surgery, Regional Hospital West Jutland; Department of Clinical Epidemiology, Aarhus University Hospital
Background: Despite advances in techniques of orthopedic surgery and improvement of pre- and postoperative treatment, hip fracture surgery is often associated with blood loss causing postoperative anemia.
Purpose / Aim of Study: Using red blood cell (RBC) transfusion as a surrogate for post-operative bleeding, the aim was to investigate if prescription drugs with anti-inflammatory properties such as NSAIDs, corticosteroids and statins increased the risk of RBC transfusion within the first week after hip fracture surgery in elderly patients in Denmark.
Materials and Methods: 56,420 surgery treated hip fracture patients aged 65 years or older registered in the Danish Multidisciplinary Hip Fracture Database in 2005-2013 were included. Information on treatment, transfusion, medication and comorbidities were collected using national administrative and clinical databases. Patients were categorized as non-users (no prescription ≤365 days prior to surgery), former users (one prescription ≤ 91-365 days) and current users (one prescription ≤ 90 days) of the three anti-inflammatory drugs. A log-binomial model was used to estimate relative risks (RRs) for RBC transfusion within 7 days of surgery and corresponding 95% confidence intervals (CIs). Adjustments were made for patient and surgery related factors.
Findings / Results: Current users of NSAIDs had an increased adjusted RR of transfusion (1.07, CI: 1.04 - 1.11) compared to non- users. There were no increase or decrease in RRs of transfusion for current users of corticosteroids and statins (0.97, CI: 0.93 - 1.01 and 1.03, CI: 1.00 - 1.05, respectively).
Conclusions: NSAID prescription within the last 90 days of a hip fracture surgery resulted in an increased risk of RBC transfusion. Thus, prescription of NSAID can be associated with an increased risk of post- operative bleeding in relation to hip fracture surgery.
Alma B Pedersen , Vera Ehrenstein, Szimonetta K. Szépligeti, Henrik T Sørensen
Department of Clinical Epidemiology, Aarhus Universityhospital; Department of Clinical Epidemiology, Aarhus Universityhospital; Department of Clinical Epidemiology, Aarhus Universityhospital; Department of Clinical Epidemiology, Aarhus Universityhospital
Background: Hip fracture is a common trauma, associated with high morbidity and mortality.
Purpose / Aim of Study: We evaluated risks of MI and stroke in hip fracture patients compared with general population. We also examined the interaction between hip fracture and comorbidity with respect to risks of MI or stroke, defined as excess of risk explained by combining risks of hip fracture and comorbidity.
Materials and Methods: A population-based cohort study using Danish health registries from 1995-2015 including 110,563 hip fracture patients and 552,774 members of the 2015 including 110,563 hip fracture patients and 552,774 members of the comparison cohort from the general population. comparison cohort from the general population.
Findings / Results: Thirty-day cumulative incidences of MI were 1.15% among patients with hip fracture and 0.09% in the general population (adjusted hazard ratio (aHR) = 12.97 (95% confidence interval (CI): 11.56-14.55)). Thirty-day cumulative incidences of stroke were 2.16% for hip fracture patients and 0.21% in the general population (aHR= 9.42 (95% CI: 8.71-10.19)). During the 31-365 days following hip fracture, the aHR for MI was 1.05 (95% CI: 0.97-1.14) and remained at this level during the remainder of follow-up (maximum of 20 years). The aHR for stroke was 1.29 (95% CI: 1.22-1.35) during the 31-365 days following hip fracture, remained elevated for up to 10 years, and then decreased to the general-population level. During the first 30 days, up to 76% of MI and stroke risk was attributable to interaction between hip fracture and comorbidity.
Conclusions: Patients with hip fracture are at increased risk of both MI and stroke up to one year following the fracture. Risk of stroke, but not of MI, was elevated during up to 10 years post-fracture. Although the absolute risks were low, our finding underscores the importance of targeting multimorbidity, including prevention and adequate treatment, to improve the prognosis of hip fracture patients.
Department of Clinical Epidemiology, Aarhus Universityhospital; Department of Clinical Epidemiology, Aarhus Universityhospital; Department of Clinical Epidemiology, Aarhus Universityhospital; Department of Clinical Epidemiology, Aarhus Universityhospital
Background: Hip fracture is a common trauma, associated with high morbidity and mortality.
Purpose / Aim of Study: We evaluated risks of MI and stroke in hip fracture patients compared with general population. We also examined the interaction between hip fracture and comorbidity with respect to risks of MI or stroke, defined as excess of risk explained by combining risks of hip fracture and comorbidity.
Materials and Methods: A population-based cohort study using Danish health registries from 1995-2015 including 110,563 hip fracture patients and 552,774 members of the 2015 including 110,563 hip fracture patients and 552,774 members of the comparison cohort from the general population. comparison cohort from the general population.
Findings / Results: Thirty-day cumulative incidences of MI were 1.15% among patients with hip fracture and 0.09% in the general population (adjusted hazard ratio (aHR) = 12.97 (95% confidence interval (CI): 11.56-14.55)). Thirty-day cumulative incidences of stroke were 2.16% for hip fracture patients and 0.21% in the general population (aHR= 9.42 (95% CI: 8.71-10.19)). During the 31-365 days following hip fracture, the aHR for MI was 1.05 (95% CI: 0.97-1.14) and remained at this level during the remainder of follow-up (maximum of 20 years). The aHR for stroke was 1.29 (95% CI: 1.22-1.35) during the 31-365 days following hip fracture, remained elevated for up to 10 years, and then decreased to the general-population level. During the first 30 days, up to 76% of MI and stroke risk was attributable to interaction between hip fracture and comorbidity.
Conclusions: Patients with hip fracture are at increased risk of both MI and stroke up to one year following the fracture. Risk of stroke, but not of MI, was elevated during up to 10 years post-fracture. Although the absolute risks were low, our finding underscores the importance of targeting multimorbidity, including prevention and adequate treatment, to improve the prognosis of hip fracture patients.
Cecilie Daugaard, Nickolaj Risbo Kristensen, Alma Becic Pedersen, Søren Paaske Johnsen
Department of Clinical Epidemiology, Aarhus University Hospital; Department of Clinical Epidemiology, Aarhus University Hospital; Department of Clinical Epidemiology, Aarhus University Hospital; Department of Clinical Epidemiology, Aarhus University Hospital
Background: Hip fracture is associated with high bleeding risk and mortality. The patients are often elderly and comorbid requiring various drugs, however, little is known about the effect of ongoing antithrombotic therapy on outcome among patients undergoing hip fracture surgery.
Purpose / Aim of Study: To determine if anticoagulants and antiplatelets are associated with increased use of blood transfusion and 30 days mortality among hip fracture patients.
Materials and Methods: A nationwide cohort study was performed. We included 56,420 patients aged ≥ 65 years who underwent hip fracture surgery during 2005-2013, using the Danish Hip Fracture Database. Patient characteristics were depicted according to antithrombotic treatment. We determined and compared the cumulative risk of blood transfusion within 7 days of surgery and death within 30 days.
Findings / Results: Following hip fracture surgery, 47.7% received blood transfusion and 10.7% died within 30 days. Current vitamin K antagonists (VKA) treatment at the time of hip fracture did not increase the risk of transfusion; adj. relative risk (RR) was 0.97 (95% CI 0.93-1.02) nor the risk of 30 days mortality; adj. hazard ratio (HR) was 0.92 (95% CI 0.79-1.07). In contrast, both the risk of transfusion and 30 days mortality was increased among hip fracture patients on antiplatelet therapy. The adj. RR for transfusion was 1.14 (95% CI 1.11-1.18) and adj. HR for 30 days mortality was 1.19 (95% CI 1.13-1.26). Updated data including data on non-vitamin K antagonist oral anticoagulants will be available at the meeting.
Conclusions: Hip fracture patients preoperatively treated with VKA had no increased risk of transfusion or 30 days mortality. In contrast, use of antiplatelet drugs was associated with significantly increased risk of transfusion and higher 30 days all-cause mortality.
Department of Clinical Epidemiology, Aarhus University Hospital; Department of Clinical Epidemiology, Aarhus University Hospital; Department of Clinical Epidemiology, Aarhus University Hospital; Department of Clinical Epidemiology, Aarhus University Hospital
Background: Hip fracture is associated with high bleeding risk and mortality. The patients are often elderly and comorbid requiring various drugs, however, little is known about the effect of ongoing antithrombotic therapy on outcome among patients undergoing hip fracture surgery.
Purpose / Aim of Study: To determine if anticoagulants and antiplatelets are associated with increased use of blood transfusion and 30 days mortality among hip fracture patients.
Materials and Methods: A nationwide cohort study was performed. We included 56,420 patients aged ≥ 65 years who underwent hip fracture surgery during 2005-2013, using the Danish Hip Fracture Database. Patient characteristics were depicted according to antithrombotic treatment. We determined and compared the cumulative risk of blood transfusion within 7 days of surgery and death within 30 days.
Findings / Results: Following hip fracture surgery, 47.7% received blood transfusion and 10.7% died within 30 days. Current vitamin K antagonists (VKA) treatment at the time of hip fracture did not increase the risk of transfusion; adj. relative risk (RR) was 0.97 (95% CI 0.93-1.02) nor the risk of 30 days mortality; adj. hazard ratio (HR) was 0.92 (95% CI 0.79-1.07). In contrast, both the risk of transfusion and 30 days mortality was increased among hip fracture patients on antiplatelet therapy. The adj. RR for transfusion was 1.14 (95% CI 1.11-1.18) and adj. HR for 30 days mortality was 1.19 (95% CI 1.13-1.26). Updated data including data on non-vitamin K antagonist oral anticoagulants will be available at the meeting.
Conclusions: Hip fracture patients preoperatively treated with VKA had no increased risk of transfusion or 30 days mortality. In contrast, use of antiplatelet drugs was associated with significantly increased risk of transfusion and higher 30 days all-cause mortality.
Alma B. Pedersen, Vera Ehrenstein, Szimonetta Szépligeti, Henrik T. Sørensen
Department of Clinical Epidemiolgy, Aarhus Universityhospital; Department of Clinical Epidemiolgy, Aarhus Universityhospital; Department of Clinical Epidemiolgy, Aarhus Universityhospital; Department of Clinical Epidemiolgy, Aarhus Universityhospital
Background: Hip fracture patients are at increased risk of venous thromboembolism (VTE). The magnitude or duration of potential excess VTE risk among hip fracture patients and the duration of this potential risk have not yet been studied.
Purpose / Aim of Study: We examined the risk of VTE in hip fracture patients and a comparison cohort from the general population over a 20-year period, both overall and by comorbidity level.
Materials and Methods: Nationwide cohort study based on prospectively collected data from Danish health registries. We identified patients who were aged >55 years with incident hip fracture (n= 110,563) between 1995 and 2015. We sampled a comparison cohort without hip fracture from the general population (n= 552,774).
Findings / Results: Among hip fracture patients, the cumulative incidences of VTE were 0.73% within 30 days and 0.83% within 31-365 days. Corresponding cumulative incidences in the general population were 0.05% and 0.43%, respectively. Adjusted hazard ratios (HRs) of VTE among hip fracture patients were 17.29 [95% CI: 14.74-20.28] during the first 30 days and 2.13 (95% CI: 1.95 20.28] during the first 30 days and 2.13 (95% CI: 1.95-2.32) during 31-365 days compared with the general population. The relative risks of VTE also were 1.03 (95% CI: 0.96-1.11) and 1.11 (95% CI: 1.00-1.23) during 1-5 years and 6-10 years following hip fracture. During the first 30 days and 31-365 days following hip fracture, 14%/28% of VTE rates and 5%/4% of VTE rates were attributable to the interaction between hip fracture and severe/very severe comorbidity, respectively.
Conclusions: Hip fracture patients were at increased excess risk of VTE up to one year following their fracture.The interaction between hip fracture and comorbidity could explain up to 23% of VTE risk within 30 days following hip fracture in patients with severe and very severe comorbidity.
Department of Clinical Epidemiolgy, Aarhus Universityhospital; Department of Clinical Epidemiolgy, Aarhus Universityhospital; Department of Clinical Epidemiolgy, Aarhus Universityhospital; Department of Clinical Epidemiolgy, Aarhus Universityhospital
Background: Hip fracture patients are at increased risk of venous thromboembolism (VTE). The magnitude or duration of potential excess VTE risk among hip fracture patients and the duration of this potential risk have not yet been studied.
Purpose / Aim of Study: We examined the risk of VTE in hip fracture patients and a comparison cohort from the general population over a 20-year period, both overall and by comorbidity level.
Materials and Methods: Nationwide cohort study based on prospectively collected data from Danish health registries. We identified patients who were aged >55 years with incident hip fracture (n= 110,563) between 1995 and 2015. We sampled a comparison cohort without hip fracture from the general population (n= 552,774).
Findings / Results: Among hip fracture patients, the cumulative incidences of VTE were 0.73% within 30 days and 0.83% within 31-365 days. Corresponding cumulative incidences in the general population were 0.05% and 0.43%, respectively. Adjusted hazard ratios (HRs) of VTE among hip fracture patients were 17.29 [95% CI: 14.74-20.28] during the first 30 days and 2.13 (95% CI: 1.95 20.28] during the first 30 days and 2.13 (95% CI: 1.95-2.32) during 31-365 days compared with the general population. The relative risks of VTE also were 1.03 (95% CI: 0.96-1.11) and 1.11 (95% CI: 1.00-1.23) during 1-5 years and 6-10 years following hip fracture. During the first 30 days and 31-365 days following hip fracture, 14%/28% of VTE rates and 5%/4% of VTE rates were attributable to the interaction between hip fracture and severe/very severe comorbidity, respectively.
Conclusions: Hip fracture patients were at increased excess risk of VTE up to one year following their fracture.The interaction between hip fracture and comorbidity could explain up to 23% of VTE risk within 30 days following hip fracture in patients with severe and very severe comorbidity.
Stine Bakkensen Bruun, Irene Petersen, Deirdre Cronin-Fenton, Alma Becic Pedersen
Department of Clinical Epidemiology, Aarhus University Hospital; Department of Primary Care and Population Health, University College of London; Department of Clinical Epidemiology, Aarhus University Hospital; Department of Clinical Epidemiology, Aarhus University Hospital
Background: Hip fracture is a common trauma associated with high morbidity and mortality. 1/3 of hip fracture patients have at least one chronic comorbid condition and receive multiple prescription medications. Depression is common in elderly patients and despite concerns regarding adverse effects, selective serotonin reuptake inhibitors (SSRI) are prescribed as first choice treatment.
Purpose / Aim of Study: To examine the prevalence of SSRI use among elderly hip fracture patients in Denmark during 2006-2012 and to identify factors associated with SSRI use.
Materials and Methods: We conducted a nationwide cohort study. During 2006-2012 hip fracture surgery patients aged ≥65 years were identified using the Danish Multidisciplinary Hip Fracture Database. We tabulated patient characteristics by SSRI status. The association between patient characteristics and SSRI use were estimated as prevalence risk ratios (PRR) with 95% confidence interval (CI) using Poisson regression analyses. Comorbidity was assessed using the Charlson Comorbidity index (CCI).
Findings / Results: Among 44,788 patients, 27.29% redeemed at least one prescription for SSRI’s within two years prior to surgery. The prevalence of SSRI use decreased from 27.68% (CI 26.57%-28.81%) in 2006 to 25.27% (CI 24.19%-26.37%) in 2012. Factors associated with SSRI use were female gender (PRR = 1.15; CI 1.10-1.19), age between 75-84 and above 85 years (PRR = 1.10; CI 1.04-1.16 and PRR = 1.11; CI 1.05-1.17 respectively), CCI medium (score 1-2) (PRR = 1.34; CI 1.28-1.40) and CCI high (score >=3) (PRR = 1.42; CI 1.35-1.50).
Conclusions: More than 1/4 of Danish hip fracture patients had a prescription for SSRI although the use is decreasing. Female gender, older age and higher CCI score were associated with SSRI use. Our data can provide a basis for improving the safety of SSRI use in elderly hip fracture patients.
Department of Clinical Epidemiology, Aarhus University Hospital; Department of Primary Care and Population Health, University College of London; Department of Clinical Epidemiology, Aarhus University Hospital; Department of Clinical Epidemiology, Aarhus University Hospital
Background: Hip fracture is a common trauma associated with high morbidity and mortality. 1/3 of hip fracture patients have at least one chronic comorbid condition and receive multiple prescription medications. Depression is common in elderly patients and despite concerns regarding adverse effects, selective serotonin reuptake inhibitors (SSRI) are prescribed as first choice treatment.
Purpose / Aim of Study: To examine the prevalence of SSRI use among elderly hip fracture patients in Denmark during 2006-2012 and to identify factors associated with SSRI use.
Materials and Methods: We conducted a nationwide cohort study. During 2006-2012 hip fracture surgery patients aged ≥65 years were identified using the Danish Multidisciplinary Hip Fracture Database. We tabulated patient characteristics by SSRI status. The association between patient characteristics and SSRI use were estimated as prevalence risk ratios (PRR) with 95% confidence interval (CI) using Poisson regression analyses. Comorbidity was assessed using the Charlson Comorbidity index (CCI).
Findings / Results: Among 44,788 patients, 27.29% redeemed at least one prescription for SSRI’s within two years prior to surgery. The prevalence of SSRI use decreased from 27.68% (CI 26.57%-28.81%) in 2006 to 25.27% (CI 24.19%-26.37%) in 2012. Factors associated with SSRI use were female gender (PRR = 1.15; CI 1.10-1.19), age between 75-84 and above 85 years (PRR = 1.10; CI 1.04-1.16 and PRR = 1.11; CI 1.05-1.17 respectively), CCI medium (score 1-2) (PRR = 1.34; CI 1.28-1.40) and CCI high (score >=3) (PRR = 1.42; CI 1.35-1.50).
Conclusions: More than 1/4 of Danish hip fracture patients had a prescription for SSRI although the use is decreasing. Female gender, older age and higher CCI score were associated with SSRI use. Our data can provide a basis for improving the safety of SSRI use in elderly hip fracture patients.
Rajzan Joanroy, Jesper Stork-Hansen, Lars Rotwitt, Bjarke Viberg
Department of Orthopaedic Surgery and Traumatology, Kolding Hospital – part of Hospital Lillebaelt; Department of Orthopaedic Surgery and Traumatology, Kolding Hospital – part of Hospital Lillebaelt; Department of Orthopaedic Surgery and Traumatology, Kolding Hospital – part of Hospital Lillebaelt; 1. Department of Orthopaedic Surgery and Traumatology. 2. Institute for Regional Health Research, 1. Kolding Hospital – part of Hospital Lillebaelt. 2. University of Southern Denmark
Background: Cemented hemiarthroplasty is a well- documented treatment for patients presenting with femoral neck fractures (FNFs). However, there are not many cohort studies comparing different types of hemiarthroplasty (HA).
Purpose / Aim of Study: To compare CPT and Lubinus SP2 HA for FNF patients concerning complications and radiological measurements.
Materials and Methods: From January 1st 2013, CPT was primarily used as the new cemented HA due to a regional procurement. The Lubinus SP2 was the used HA prior to CPT. Data from 3 years prior and after introduction of CPT was retrieved from the hospital database using the NOMESCO procedure code KNFB12. All patient health records were retrospectively reviewed for types of implant, American Society of Anaesthesiologists (ASA) score, duration of admission, mortality, and major complications within 1 year. All x-ray images were analyzed for radiological measurements concerning offset, stem angulation and cement filling.
Findings / Results: There were 300 patients with CPT and 287 with Lubinus SP2. The mean age (SD) was 82.0 (8.2) years and 74.7% were female. There were 7.3% major complications for CPT and 7.6% for Lubinus SP2 resulting in no difference between the groups (p<0.527). There was no baseline difference in age, sex, ASA score, and mortality, but the admission length was 0.7 day shorter for the CPT group (p<0.004). The Lubinus SP2 had a mean plus 2.7 mm offset postoperatively compared to preoperatively (p<0.001) while CPT had plus 10.6 mm (p<0.000). The mean (SD) angle of the stems where 6.4 (1.7) degrees for Lubinus SP2 and 2.5 (1.9) for CPT (p<0.000). There was no difference in cementation (p<0.316).
Conclusions: There was no difference between the CPT and Lubinus SP2 stem regarding major complications. However, the CPT stem had overcorrection of offset and a higher degree of varus positioning.
Department of Orthopaedic Surgery and Traumatology, Kolding Hospital – part of Hospital Lillebaelt; Department of Orthopaedic Surgery and Traumatology, Kolding Hospital – part of Hospital Lillebaelt; Department of Orthopaedic Surgery and Traumatology, Kolding Hospital – part of Hospital Lillebaelt; 1. Department of Orthopaedic Surgery and Traumatology. 2. Institute for Regional Health Research, 1. Kolding Hospital – part of Hospital Lillebaelt. 2. University of Southern Denmark
Background: Cemented hemiarthroplasty is a well- documented treatment for patients presenting with femoral neck fractures (FNFs). However, there are not many cohort studies comparing different types of hemiarthroplasty (HA).
Purpose / Aim of Study: To compare CPT and Lubinus SP2 HA for FNF patients concerning complications and radiological measurements.
Materials and Methods: From January 1st 2013, CPT was primarily used as the new cemented HA due to a regional procurement. The Lubinus SP2 was the used HA prior to CPT. Data from 3 years prior and after introduction of CPT was retrieved from the hospital database using the NOMESCO procedure code KNFB12. All patient health records were retrospectively reviewed for types of implant, American Society of Anaesthesiologists (ASA) score, duration of admission, mortality, and major complications within 1 year. All x-ray images were analyzed for radiological measurements concerning offset, stem angulation and cement filling.
Findings / Results: There were 300 patients with CPT and 287 with Lubinus SP2. The mean age (SD) was 82.0 (8.2) years and 74.7% were female. There were 7.3% major complications for CPT and 7.6% for Lubinus SP2 resulting in no difference between the groups (p<0.527). There was no baseline difference in age, sex, ASA score, and mortality, but the admission length was 0.7 day shorter for the CPT group (p<0.004). The Lubinus SP2 had a mean plus 2.7 mm offset postoperatively compared to preoperatively (p<0.001) while CPT had plus 10.6 mm (p<0.000). The mean (SD) angle of the stems where 6.4 (1.7) degrees for Lubinus SP2 and 2.5 (1.9) for CPT (p<0.000). There was no difference in cementation (p<0.316).
Conclusions: There was no difference between the CPT and Lubinus SP2 stem regarding major complications. However, the CPT stem had overcorrection of offset and a higher degree of varus positioning.
Klaus D. Sander, Michael Brix, Jesper O. Schønnemann
Trauma Section, Orthopedic Clinic, Hospital of Southern Jutland; Trauma Section, Department of Orthopedic Surgery, Odense University Hospital; Trauma Section, Orthopaedic Clinic, Hospital of Southern Jutland
Background: In Denmark, we have a national consensus to treat instable trochanteric fractures with intramedullary nails (IMN), but the recommended length of IMN is still to be clarified. Long IMN inserted to the corresponding leading edge of patella has been suggested as the treatment of choice to reduce the risk of fractures below the nail or in line with distal locking screws. However, short IMN has other advantages such as shorter surgery time and lower economical costs.
Purpose / Aim of Study: The aim of this study was to compare the risk of perioperative complications and reoperations following long and short IMN in instable trochanteric fractures.
Materials and Methods: In the Danish Fracture Database (DFDB) we identified all patients with instable trochanteric fractures (AO type 31A (1-3)) treated with long IMN or short IMN in the period 2011-2014 and included information on perioperative complications. Data were linked to the Danish Interdisciplinary Registry of Hip-Near Fractures (DIRH) to obtain information on reoperations within 2 years after primary osteosynthesis
Findings / Results: We included 1513 patients registered in DFDB with an instable trochanteric fracture treated with long IMN (n = 451) or short IMN (n = 1062). The prevalence of perioperative complications was 27 for short IMN (2.5%) and 10 for long IMN (2.22%) (P>0.05). Data on reoperations registered in DIRH are still pending.
Conclusions: We found no difference in perioperative complications in patients with instable trochanteric fractures treated with long IMN or short IMN. Data on reoperations are still to be analyzed.
Trauma Section, Orthopedic Clinic, Hospital of Southern Jutland; Trauma Section, Department of Orthopedic Surgery, Odense University Hospital; Trauma Section, Orthopaedic Clinic, Hospital of Southern Jutland
Background: In Denmark, we have a national consensus to treat instable trochanteric fractures with intramedullary nails (IMN), but the recommended length of IMN is still to be clarified. Long IMN inserted to the corresponding leading edge of patella has been suggested as the treatment of choice to reduce the risk of fractures below the nail or in line with distal locking screws. However, short IMN has other advantages such as shorter surgery time and lower economical costs.
Purpose / Aim of Study: The aim of this study was to compare the risk of perioperative complications and reoperations following long and short IMN in instable trochanteric fractures.
Materials and Methods: In the Danish Fracture Database (DFDB) we identified all patients with instable trochanteric fractures (AO type 31A (1-3)) treated with long IMN or short IMN in the period 2011-2014 and included information on perioperative complications. Data were linked to the Danish Interdisciplinary Registry of Hip-Near Fractures (DIRH) to obtain information on reoperations within 2 years after primary osteosynthesis
Findings / Results: We included 1513 patients registered in DFDB with an instable trochanteric fracture treated with long IMN (n = 451) or short IMN (n = 1062). The prevalence of perioperative complications was 27 for short IMN (2.5%) and 10 for long IMN (2.22%) (P>0.05). Data on reoperations registered in DIRH are still pending.
Conclusions: We found no difference in perioperative complications in patients with instable trochanteric fractures treated with long IMN or short IMN. Data on reoperations are still to be analyzed.
Bjarke Viberg, Per Hviid Gundtoft, Jesper Schønnemann, Lasse Pedersen, Lis Røhl Andersen, Kjell Titlestad, Jens Lauritsen, Søren Overgaard
Department of Orthopaedic Surgery and Traumatology, Department of Clinical Research, Institute of Regional Health Research, Kolding Hospital - part of Lillebaelt Hospital, Odense University Hospital, University of Southern Denmark; Department of Orthopaedic Surgery and Traumatology, Kolding Hospital – part of Hospital Lillebaelt; Department of Orthopaedic Surgery and Traumatology, Hospital of Southern Jutland; Department of Orthopaedic Surgery and Traumatology, Hospital of South West Jutland; Department of Orthopaedic Surgery and Traumatology, Kolding Hospital – part of Hospital Lillebaelt; Department of Clinical Immunology, Odense University Hospital; Department of Orthopaedic Surgery and Traumatology, Department of Clinical Research, Odense University Hospital, University of Southern Denmark; Department of Orthopaedic Surgery and Traumatology, Department of Clinical Research, Odense University Hospital, University of Southern Denmark
Background: In 2014, the Danish National Clinical Guidelines (NCG) for transfusion with blood components using restrictive transfusions limits was introduced. Very few trials have evaluated the influence of restrictive transfusion limits on hip fracture patients.
Purpose / Aim of Study: To estimate the association of introducing the NCG for transfusion with blood components with mortality and transfusion frequency for hip fracture patients above 65 years.
Materials and Methods: From 01102015 to 30092016, all hospitals treating hip fracture patients in the Region of Southern Denmark adhered to the new NCG and the patients were included as the restrictive transfusion group (RG). This group was compared to a liberal transfusion group (LG) from 01102012 to 30092013. Data from the Danish Interdisciplinary Registry for Hip Fractures was collected including age, sex, Charlson Comorbidity Index (CCI), type of fracture and surgery. Data was merged with data from the Danish Transfusion Database and the Regional Laboratory Database. Statistic for comparing groups and Cox proportional hazards model was performed.
Findings / Results: 2,908 patients were included with no major baseline difference in the two groups concerning age, sex, CCI, type of fracture, or type of surgery. The 30-day mortality was 12% in LG (n=1,494) and 9% in RG (n=1,414) yielding a relative risk of 0.74 (0.59; 0.94) for RG compared to LG (adjusted for age, sex, CCI, and type of surgery). In LG 42% received blood transfusions compared to 30% in RG (p<0.001). The mean (CI) hemoglobin at the first transfusion was 5.65 mmol/l (5.57;5.72) in LG and 5.16 mmol/l (5.08;5.24) in RG (p<0.001).
Conclusions: The restrictive NCG lowered the percentage of patients transfused with blood components without increasing the overall mortality rate. Thus, it seems safe to implement this guideline for hip fracture patients.
Department of Orthopaedic Surgery and Traumatology, Department of Clinical Research, Institute of Regional Health Research, Kolding Hospital - part of Lillebaelt Hospital, Odense University Hospital, University of Southern Denmark; Department of Orthopaedic Surgery and Traumatology, Kolding Hospital – part of Hospital Lillebaelt; Department of Orthopaedic Surgery and Traumatology, Hospital of Southern Jutland; Department of Orthopaedic Surgery and Traumatology, Hospital of South West Jutland; Department of Orthopaedic Surgery and Traumatology, Kolding Hospital – part of Hospital Lillebaelt; Department of Clinical Immunology, Odense University Hospital; Department of Orthopaedic Surgery and Traumatology, Department of Clinical Research, Odense University Hospital, University of Southern Denmark; Department of Orthopaedic Surgery and Traumatology, Department of Clinical Research, Odense University Hospital, University of Southern Denmark
Background: In 2014, the Danish National Clinical Guidelines (NCG) for transfusion with blood components using restrictive transfusions limits was introduced. Very few trials have evaluated the influence of restrictive transfusion limits on hip fracture patients.
Purpose / Aim of Study: To estimate the association of introducing the NCG for transfusion with blood components with mortality and transfusion frequency for hip fracture patients above 65 years.
Materials and Methods: From 01102015 to 30092016, all hospitals treating hip fracture patients in the Region of Southern Denmark adhered to the new NCG and the patients were included as the restrictive transfusion group (RG). This group was compared to a liberal transfusion group (LG) from 01102012 to 30092013. Data from the Danish Interdisciplinary Registry for Hip Fractures was collected including age, sex, Charlson Comorbidity Index (CCI), type of fracture and surgery. Data was merged with data from the Danish Transfusion Database and the Regional Laboratory Database. Statistic for comparing groups and Cox proportional hazards model was performed.
Findings / Results: 2,908 patients were included with no major baseline difference in the two groups concerning age, sex, CCI, type of fracture, or type of surgery. The 30-day mortality was 12% in LG (n=1,494) and 9% in RG (n=1,414) yielding a relative risk of 0.74 (0.59; 0.94) for RG compared to LG (adjusted for age, sex, CCI, and type of surgery). In LG 42% received blood transfusions compared to 30% in RG (p<0.001). The mean (CI) hemoglobin at the first transfusion was 5.65 mmol/l (5.57;5.72) in LG and 5.16 mmol/l (5.08;5.24) in RG (p<0.001).
Conclusions: The restrictive NCG lowered the percentage of patients transfused with blood components without increasing the overall mortality rate. Thus, it seems safe to implement this guideline for hip fracture patients.
Buket Öztürk, Søren P. Johnsen, Niels D. Röck, Alma B. Pedersen
Department of Clinical Epidemiology, Aarhus University Hospital; Department of Clinical Epidemiology, Aarhus University Hospital; Department of Orthopedic Surgery, Odense University Hospital; Department of Clinical Epidemiology, Aarhus University Hospital
Background: The effect of the timing of hip fracture surgery on mortality was studied extensively but the findings are not conclusive. It is generally thought that earlier surgery leads to lower mortality, but the correct threshold is unknown.
Purpose / Aim of Study: To investigate whether the association between surgery delay and mortality varies by comorbidity level.
Materials and Methods: Using data from Danish registers, 24,819 hip fracture surgery patients (2008 – 2012) were identified. 30-days and 31-365-days all-cause mortality was determined. Adjusted Odds Ratios (OR) and Hazard Ratios (HR) with 95% confidence interval (CI) were calculated. We defined comorbidity according to Charlson Comorbidity Index (CCI): low (score of 0), medium (score of 1-2) and high (score of 3+).
Findings / Results: ORs for 30-days mortality in patients with low CCI were 1.20 (CI: 1.03;1.39) if surgery delay was >24 vs <24 hours and 1.46 (CI: 1.12;1.92) if surgery delay was >48 vs <48 hours. This increase in 30-days mortality was not p present for patients with medium or h high CCI. HRs for 31-365 days mortality in patients with low CCI were 1.10 (CI: 1.00;1.22) for surgery delay >24 vs <24 hours and 1.20 (CI: 1.00;1.44) for surgery delay >48 vs <48 hours. In patients with medium CCI corresponding HRs were 1.12 (CI: 1.02;1.23) and 1.27 (CI: 1.07;1.50). No increase in 31-365 days mortality was p present among patients with high CCI.
Conclusions: The association between surgery delay and mortality is dependent on the presence of comorbidity at the time of the hip fracture. Mortality is increased among hip fracture patients free of comorbidity when surgery is delayed >24 hours, while patients with high comorbidity do not have the same increased mortality when surgery is delayed. These findings may reflect differences in the optimization focus depending on the level of comorbidity.
Department of Clinical Epidemiology, Aarhus University Hospital; Department of Clinical Epidemiology, Aarhus University Hospital; Department of Orthopedic Surgery, Odense University Hospital; Department of Clinical Epidemiology, Aarhus University Hospital
Background: The effect of the timing of hip fracture surgery on mortality was studied extensively but the findings are not conclusive. It is generally thought that earlier surgery leads to lower mortality, but the correct threshold is unknown.
Purpose / Aim of Study: To investigate whether the association between surgery delay and mortality varies by comorbidity level.
Materials and Methods: Using data from Danish registers, 24,819 hip fracture surgery patients (2008 – 2012) were identified. 30-days and 31-365-days all-cause mortality was determined. Adjusted Odds Ratios (OR) and Hazard Ratios (HR) with 95% confidence interval (CI) were calculated. We defined comorbidity according to Charlson Comorbidity Index (CCI): low (score of 0), medium (score of 1-2) and high (score of 3+).
Findings / Results: ORs for 30-days mortality in patients with low CCI were 1.20 (CI: 1.03;1.39) if surgery delay was >24 vs <24 hours and 1.46 (CI: 1.12;1.92) if surgery delay was >48 vs <48 hours. This increase in 30-days mortality was not p present for patients with medium or h high CCI. HRs for 31-365 days mortality in patients with low CCI were 1.10 (CI: 1.00;1.22) for surgery delay >24 vs <24 hours and 1.20 (CI: 1.00;1.44) for surgery delay >48 vs <48 hours. In patients with medium CCI corresponding HRs were 1.12 (CI: 1.02;1.23) and 1.27 (CI: 1.07;1.50). No increase in 31-365 days mortality was p present among patients with high CCI.
Conclusions: The association between surgery delay and mortality is dependent on the presence of comorbidity at the time of the hip fracture. Mortality is increased among hip fracture patients free of comorbidity when surgery is delayed >24 hours, while patients with high comorbidity do not have the same increased mortality when surgery is delayed. These findings may reflect differences in the optimization focus depending on the level of comorbidity.
Pia Kjær Kristensen, Rikke Søgaard, Theis Thillemann, Kjeld Søballe, Søren Paaske Johnsen
Orthopaedic department and Department of clinical Epidemiology, Horsens and Aarhus University Hospital; Public Health, Aarhus University; Orthopeadic Department, Aarhus University Hospital; Orthopeadic Department, Aarhus University Hospital; Department of Clinical Epidemiology, Aarhus Univerity Hospital
Background: It is unknown whether improvements in quality of care will require increased health care spending or whether improvements in quality of care will lead to a reduction in adverse patient outcomes, including fewer complications and readmissions.
Purpose / Aim of Study: To examine whether fulfilment of process performance measures reflecting national guideline are associated with hospital costs among hip fracture patients
Materials and Methods: We identified 20,458 hip fracture patients ≥ 65 years based on prospectively collected data from the Danish Multidisciplinary Hip Fracture Registry. Quality of care were defined as fulfilment of seven process performance measures from the national multidisciplinary guideline for in-hospital care: systematic pain assessment, early mobilisation, basic mobility assessment before admission and discharge, post discharge rehabilitation program, anti- osteoporotic medication and prevention of future fall accidents. Total costs were defined as the sum of costs used for treating the individual patient according to the Danish Reference Cost Database.
Findings / Results: Fulfilment of the individual process performance measures were associated with lower total costs within the index admission. The adjusted ratio ranged from 0.90 (95% Confidence Interval (CI): 0.88-0.91) to 0.97 (95% CI: 0.95-0.99), corresponding to adjusted mean differences between EUR305 to EUR3534 when compared to patients where the care did not fulfil the measures. Receiving between 50% to 75% or more than 75% of the performance measures were also associated with lower total costs. The association were weakened when taking into account all costs related to hospitalisations within the first year.
Conclusions: High quality of care appear not to imply increased spending and may even lead to lower hospital costs for the index admission and within the first year.
Orthopaedic department and Department of clinical Epidemiology, Horsens and Aarhus University Hospital; Public Health, Aarhus University; Orthopeadic Department, Aarhus University Hospital; Orthopeadic Department, Aarhus University Hospital; Department of Clinical Epidemiology, Aarhus Univerity Hospital
Background: It is unknown whether improvements in quality of care will require increased health care spending or whether improvements in quality of care will lead to a reduction in adverse patient outcomes, including fewer complications and readmissions.
Purpose / Aim of Study: To examine whether fulfilment of process performance measures reflecting national guideline are associated with hospital costs among hip fracture patients
Materials and Methods: We identified 20,458 hip fracture patients ≥ 65 years based on prospectively collected data from the Danish Multidisciplinary Hip Fracture Registry. Quality of care were defined as fulfilment of seven process performance measures from the national multidisciplinary guideline for in-hospital care: systematic pain assessment, early mobilisation, basic mobility assessment before admission and discharge, post discharge rehabilitation program, anti- osteoporotic medication and prevention of future fall accidents. Total costs were defined as the sum of costs used for treating the individual patient according to the Danish Reference Cost Database.
Findings / Results: Fulfilment of the individual process performance measures were associated with lower total costs within the index admission. The adjusted ratio ranged from 0.90 (95% Confidence Interval (CI): 0.88-0.91) to 0.97 (95% CI: 0.95-0.99), corresponding to adjusted mean differences between EUR305 to EUR3534 when compared to patients where the care did not fulfil the measures. Receiving between 50% to 75% or more than 75% of the performance measures were also associated with lower total costs. The association were weakened when taking into account all costs related to hospitalisations within the first year.
Conclusions: High quality of care appear not to imply increased spending and may even lead to lower hospital costs for the index admission and within the first year.
Rikke Beckermann
Clinic for Neuro- and Orthopedic Diseases, Aalborg University Hospital
Background: For several years, it has been a challenge to reach the national standard of 90% postoperative survival for patients operated for hip fractures at Aalborg University Hospital. Waiting time for surgery has been shown to be one of the most important factors to reduce mortality.
Purpose / Aim of Study: Reducing waiting time for operation, so that 75% of all patients are operated within 24 hours and 90% within 36 hours.
Materials and Methods: The project was designed as an interdisciplinary cooperation. The group met for two seminars and six meetings to secure progress by discussing and adjusting the changing in work flows that was being tested. How we made a ”Fast Track for patients with hip fractures” • On arrival at the Emergency Room, a nurse orders blood samples, local anesthesia and x-ray right away. • The Orthopedic surgeon makes a “click- journal” as soon as possible. • The patient is transported to a Recovery Ward where an anesthesiologist ensures preoperatively optimization of the patient. • After being optimized, the patient is taken to the Operation Theatre as soon as possible. • Expansion of operation capacity by five hours in the evening two days a week.
Findings / Results: The goal is fully achieved. 100% of all patients are operated on within 36hours. The median waiting time for operation has changed from 27,6 hours in early 2016 to 12.3 hours from September to December 2016.
Conclusions: We succeded in reducing the waiting time for operation. As a part two of the project, our focus is now to improve the post-operative recovery from operation to discharge with our main focus on early mobilization and orto-geriatric cooperation. As a part tree we'll address the last part of the process - "Optimization of transition to municipalities for patients with hip fractures - after discharge from hospital to home" .
Clinic for Neuro- and Orthopedic Diseases, Aalborg University Hospital
Background: For several years, it has been a challenge to reach the national standard of 90% postoperative survival for patients operated for hip fractures at Aalborg University Hospital. Waiting time for surgery has been shown to be one of the most important factors to reduce mortality.
Purpose / Aim of Study: Reducing waiting time for operation, so that 75% of all patients are operated within 24 hours and 90% within 36 hours.
Materials and Methods: The project was designed as an interdisciplinary cooperation. The group met for two seminars and six meetings to secure progress by discussing and adjusting the changing in work flows that was being tested. How we made a ”Fast Track for patients with hip fractures” • On arrival at the Emergency Room, a nurse orders blood samples, local anesthesia and x-ray right away. • The Orthopedic surgeon makes a “click- journal” as soon as possible. • The patient is transported to a Recovery Ward where an anesthesiologist ensures preoperatively optimization of the patient. • After being optimized, the patient is taken to the Operation Theatre as soon as possible. • Expansion of operation capacity by five hours in the evening two days a week.
Findings / Results: The goal is fully achieved. 100% of all patients are operated on within 36hours. The median waiting time for operation has changed from 27,6 hours in early 2016 to 12.3 hours from September to December 2016.
Conclusions: We succeded in reducing the waiting time for operation. As a part two of the project, our focus is now to improve the post-operative recovery from operation to discharge with our main focus on early mobilization and orto-geriatric cooperation. As a part tree we'll address the last part of the process - "Optimization of transition to municipalities for patients with hip fractures - after discharge from hospital to home" .