Pub Date : 2023-11-18DOI: 10.1177/21514593231216553
K. Jeray, Setareh A. Williams, Yamei Wang, L. Pearman, N. Pyrih, Karun Singla, Benjamin H. Han, Susan V. Bukata
There are limited data on the management of bone health, including bone mineral density (BMD) evaluation and osteoporosis (OP) treatment, in patients undergoing elective orthopaedic surgeries. This was a retrospective cohort study using administrative claims data from Symphony Health, PatientSource for patients aged ≥50 years with documented kyphoplasty/vertebroplasty (KP/VP), total knee arthroplasty (TKA), and total hip arthroplasty (THA). Risk stratification to identify patients at very high risk for fracture (VHRFx) was based on clinical practice guideline recommendations to the extent information on variables of interest were available from the claims database. A total of 251 919 patients met inclusion criteria: KP/VP (31 018), TKA (149 849), and THA (71 052). The majority were female (80.3%) with a mean (SD) age of 68.5 (7.5) years. Patients undergoing KP/VP were older and had a greater comorbidity burden associated with risk for falls, mobility issues, muscle weakness, and respiratory and cardiovascular diseases. In the 6 months before surgery, 11.8% of patients were tested and/or received treatment for OP. Patients undergoing KP/VP were more likely to be tested and/or treated (17.5%) than patients undergoing TKA (11.0%) or THA (10.9%). Overall, men had a lower rate of testing and/or treatment than women (4.6% vs 13.5%). In the 12 months before surgery, patients with an OP diagnosis and at VHRFx (30.8%) had a higher rate of treatment and/or testing than those without OP (11.5%), or those without OP but with a fracture in the year preceding surgery (10.2%). Bone health management is suboptimal in patients undergoing elective orthopaedic surgeries and is worse in men than in women. Proper management of OP before and after surgery may improve outcomes.
关于接受择期骨科手术患者的骨健康管理，包括骨矿物质密度 (BMD) 评估和骨质疏松症 (OP) 治疗的数据十分有限。这是一项回顾性队列研究，使用的是 Symphony Health、PatientSource 提供的行政报销数据，对象是年龄≥50 岁、有记录的接受过椎体成形术/椎体后凸成形术 (KP/VP)、全膝关节置换术 (TKA) 和全髋关节置换术 (THA) 的患者。根据临床实践指南的建议进行风险分层，以确定骨折风险极高（VHRFx）的患者，并尽可能从索赔数据库中获得相关变量的信息。共有 251 919 名患者符合纳入标准：KP/VP（31 018 例）、TKA（149 849 例）和 THA（71 052 例）。大多数患者为女性（80.3%），平均（标清）年龄为 68.5（7.5）岁。接受 KP/VP 手术的患者年龄较大，合并症较多，有跌倒、行动不便、肌肉无力、呼吸系统和心血管疾病等风险。手术前 6 个月，11.8% 的患者接受了 OP 检测和/或治疗。与接受 TKA（11.0%）或 THA（10.9%）手术的患者相比，接受 KP/VP 手术的患者更有可能接受检测和/或治疗（17.5%）。总体而言，男性接受检测和/或治疗的比例低于女性（4.6% 对 13.5%）。在手术前的 12 个月中，确诊 OP 且处于 VHRFx 阶段的患者（30.8%）接受治疗和/或检测的比例高于未确诊 OP 的患者（11.5%），也高于未确诊 OP 但在手术前一年中发生骨折的患者（10.2%）。接受择期骨科手术的患者的骨健康管理并不理想，男性患者的情况比女性患者更差。在手术前后对 OP 进行适当管理可改善手术效果。
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Pub Date : 2023-09-06DOI: 10.1177/21514593231198949
Steven Morgan, S. Jarvis, Alexander Conti, Kelsey Staudinger, C. Reynolds, D. Bar-Or
Controversary exists around the best surgical management for traumatic geriatric displaced femoral neck fractures. The study objective was to compare outcomes among those managed with a total hip arthroplasty (THA) to those managed with a hemiarthroplasty (HA). This retrospective matched cohort study included geriatric hip fractures (≥65 y/o) admitted 7/1/16-3/31/20. Patients were matched on having an advanced directive, pre-existing dementia, and age. Outcomes included: time to surgery, length of stay (LOS), blood loss volume, and discharge destination. THAs were compared to HAs; an alpha of <.05 indicated statistical significance. There were 191 patients: 86% were treated with HA and 14% with THA. Most (40%) were 80-89 years old, 66% were female, and 92% were white. After matching, the groups were well balanced on demographics and baseline characteristics with 27 patients/arm. The median time to surgery was 23 hours for both arms, P = .38. The LOS was significantly longer for those managed with a HA when compared to those managed with a THA, 5.6 vs 4.0 days, P = .001. The median blood loss volume was significantly lower for HAs than for THAs, but the difference was small, 100 vs 120 mL, P = .02. Patients managed with a HA were less likely to be discharged home than those managed with a THA, 22% vs 70%, P = .005. While patients managed with a THA had significantly more blood loss than those managed with a HA, the difference in blood loss was small and not clinically relevant. Those managed with a THA experienced a significantly shorter LOS and were more likely to be discharged home than patients managed with a HA. Among a healthier, younger geriatric population, THA may lead to shortened LOS and improved discharge destinations when compared to HA for treatment of femoral neck fractures.
关于创伤性老年性股骨颈移位骨折的最佳手术治疗存在争议。研究的目的是比较全髋关节置换术(THA)和半髋关节置换术(HA)患者的结果。这项回顾性匹配队列研究纳入了2016年7月1日- 2016年3月31日收治的老年髋部骨折(≥65 y/o)患者。患者根据是否有高级指示、已存在的痴呆和年龄进行匹配。结果包括:手术时间、住院时间(LOS)、出血量和出院目的地。将THAs与HAs进行比较;<的值。0.05为有统计学意义。191例患者:86%接受HA治疗，14%接受THA治疗。大多数(40%)为80-89岁，66%为女性，92%为白人。匹配后，27例患者/组在人口统计学和基线特征上取得了很好的平衡。双臂手术的中位时间为23小时，P = 0.38。与THA组相比，HA组的LOS明显更长，分别为5.6天和4.0天，P = 0.001。ha组的中位失血量明显低于tha组，但差异很小，分别为100 mL和120 mL, P = 0.02。接受HA治疗的患者比接受THA治疗的患者更不可能出院回家，22% vs 70%， P = 0.005。虽然THA治疗的患者比HA治疗的患者有更多的出血量，但出血量的差异很小，没有临床相关性。与HA管理的患者相比，THA管理的患者的LOS明显更短，更有可能出院回家。在健康、年轻的老年人群中，与HA治疗股骨颈骨折相比，THA可缩短LOS和改善出院目的地。
{"title":"Displaced Geriatric Femoral Neck Fractures: A Retrospective Comparison of Total Hip Arthroplasties Versus Hemiarthroplasty","authors":"Steven Morgan, S. Jarvis, Alexander Conti, Kelsey Staudinger, C. Reynolds, D. Bar-Or","doi":"10.1177/21514593231198949","DOIUrl":"https://doi.org/10.1177/21514593231198949","url":null,"abstract":"Controversary exists around the best surgical management for traumatic geriatric displaced femoral neck fractures. The study objective was to compare outcomes among those managed with a total hip arthroplasty (THA) to those managed with a hemiarthroplasty (HA). This retrospective matched cohort study included geriatric hip fractures (≥65 y/o) admitted 7/1/16-3/31/20. Patients were matched on having an advanced directive, pre-existing dementia, and age. Outcomes included: time to surgery, length of stay (LOS), blood loss volume, and discharge destination. THAs were compared to HAs; an alpha of <.05 indicated statistical significance. There were 191 patients: 86% were treated with HA and 14% with THA. Most (40%) were 80-89 years old, 66% were female, and 92% were white. After matching, the groups were well balanced on demographics and baseline characteristics with 27 patients/arm. The median time to surgery was 23 hours for both arms, P = .38. The LOS was significantly longer for those managed with a HA when compared to those managed with a THA, 5.6 vs 4.0 days, P = .001. The median blood loss volume was significantly lower for HAs than for THAs, but the difference was small, 100 vs 120 mL, P = .02. Patients managed with a HA were less likely to be discharged home than those managed with a THA, 22% vs 70%, P = .005. While patients managed with a THA had significantly more blood loss than those managed with a HA, the difference in blood loss was small and not clinically relevant. Those managed with a THA experienced a significantly shorter LOS and were more likely to be discharged home than patients managed with a HA. Among a healthier, younger geriatric population, THA may lead to shortened LOS and improved discharge destinations when compared to HA for treatment of femoral neck fractures.","PeriodicalId":106020,"journal":{"name":"Geriatric Orthopaedic Surgery & Rehabilitation","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131060747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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