Geriatric orthopaedic surgery & rehabilitation
-
Geriatr Orthop Surg Rehabil · Jan 2018
ReviewSurgical Technical Evidence Review of Hip Fracture Surgery Conducted for the AHRQ Safety Program for Improving Surgical Care and Recovery.
Enhanced recovery pathways (ERPs) have been shown to improve patient outcomes in a variety of contexts. This review summarizes the evidence and defines a protocol for perioperative care of patients with hip fracture and was conducted for the Agency for Healthcare Research and Quality safety program for improving surgical care and recovery. ⋯ This review provides the evidence basis for an ERP for perioperative care of patients with hip fracture.
-
Geriatr Orthop Surg Rehabil · Jan 2018
Weekend Admission of Intracapsular Femoral Neck Fractures Not Associated With a Greater Rate of Mortality or Morbidity.
For a number of emergency conditions, admission over the weekend has been associated with rising morbidity and mortality rates. However, different studies have provided conflicting results regarding the increased rates of mortality and morbidity for patients with intracapsular femoral fracture who were admitted over the weekend, compared to weekdays. This study investigated the effect of weekend admissions on the surgical outcomes of patients with intracapsular femoral neck fractures. ⋯ Patients with intracapsular femoral neck fractures who were admitted over the weekend at our trauma center did not have a higher risk of mortality or morbidity. Furthermore, temporary preoperative care provided over the weekend by an internal medical consultant can be safe and efficient even in the circumstances where there is a lack of dedicated geriatric support. The absence of an elective operating list at the weekend could be a potential factor in shortening waiting times for surgery for intracapsular femoral neck fracture at weekends and holidays.
-
Geriatr Orthop Surg Rehabil · Jan 2018
Ten years of EMS Fall Calls in a Community: An Opportunity for Injury Prevention Strategies.
To determine whether fall calls, lift assists, and need for transport to the hospital over the past 10 years in one emergency medical services (EMS) system have altered coincident with demographic changes and to estimate health-care cost for lift assists. ⋯ Future work to reduce the frequency and increase the impact of EMS lift assists could have a significant cost benefit and provide opportunity for enrollment in appropriate community services and fall prevention programs.
-
Geriatr Orthop Surg Rehabil · Dec 2017
ReviewNerve Blocks in the Geriatric Patient With Hip Fracture: A Review of the Current Literature and Relevant Neuroanatomy.
Hip fracture is a common occurrence in the elderly population with high morbidity and mortality due to postoperative pain and opioid use. The goal of this article is to review the current literature on the neuroanatomy of the hip and the use of localized nerve block in controlling hip fracture pain. ⋯ Localized nerve blocks, specifically FICB, have been shown to be safe and effective in managing acute hip fracture pain in geriatric patients, leading to decreased opioid use. Knowledge of the hip neuroanatomy may help guide future development of hip fracture pain blockade.
-
Geriatr Orthop Surg Rehabil · Sep 2017
ReviewHip Fractures in Elderly People: Surgery or No Surgery? A Systematic Review and Meta-Analysis.
Increasing numbers of patients with hip fractures also have advanced comorbidities. A majority are treated surgically. However, a significantly increasing percentage of medically unfit patients with unacceptably high risk of perioperative death are treated nonoperatively. Important questions about patients' prefracture quality of life (QOL) and future perspectives should be asked before considering different treatment options to assess what kind of treatment is advisable in frail elderly high-risk patients with a hip fracture. ⋯ This systematic review and meta-analysis demonstrated that only a few studies with small number of patients comparing NOM with OM were published. A significantly higher 30-day and 1-year mortality was revealed in nonoperatively treated hip fracture patients. No data were found examining (HR)QOL and costs. Further work is needed to enable shared decision-making and to initiate NOM in frail elderly patients with advanced comorbidity and limited life expectancy.