Type of underlying fracture after the surgical treatment of geriatric trauma patients has no effect on mortality during intensive care treatment
Tom KnaufKai Oliver JensenJuliana HackJuliane BarthelHannah AlthausBenjamin BueckingRené AignerMatthias KnobeSteffen RuchholtzDaphne Eschbach
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Aim Due to demographic change, the number of geriatric patients is still rising. Although hip fractures are the subject of current research, little is known about the remaining geriatric trauma entities. The aim of this study was to collect data of the age‐related traumatological intensive care unit (ICU) population, its underlying diagnosis, and the influence on mortality and length of stay in the ICU. Methods Geriatric trauma patients (aged ≥65 years) treated postoperatively in our surgical ICU were included in this retrospective observational study covering the period 2013–2017. In addition to the underlying fracture entities, patient characteristics, such as age, sex, Charlson Comorbidity Index, length of stay and mortality, were collected to identify possible independent predictive factors for mortality in the ICU using multivariate analysis. Results During the observation period, 805 (60.5%) patients met the inclusion criteria. 47.6% of the patients suffered from a proximal femoral fracture. The total mortality rate during the stay in the ICU was 7.5%. Significant predictive factors for mortality in the ICU were Charlson Comorbidity Index ( P < 0.001) and length of stay ( P < 0.001). The different fracture types themselves were not a significant risk factor for mortality ( P = 0.862). Conclusion Patients with proximal femoral fractures account for approximately half of the patients in intensive care. The mortality rate of these patients is no higher than that in geriatric trauma patients with other fractures. The progression is essentially influenced by the patient's comorbidities. Nowadays, the focus shifts from trauma care to the therapy of concomitant diseases. Nevertheless, this cohort, when adequately treated, shows a comparatively low mortality rate. Geriatr Gerontol Int 2020; 20: 1120–1125 .Keywords:
Geriatric Trauma
Hip Fracture
Charlson comorbidity index
Objective: Comorbid conditions are known to be associated with poor prognosis in coronavirus disease 2019.This study aimed to investigate the effects of comorbidity burdens of inpatients, identified by the Charlson Comorbidity Index, on their mortalities.Methods: A total of 150 patients who presented to the emergency department of our hospital with various complaints and symptoms were diagnosed with coronavirus disease 2019 as a result of the testing and received inpatient treatment (87 males, mean age 61.6 ± 13.8 years) were included in the study.Charlson Comorbidity Index scores were calculated.Patients were classified into 2 groups based on the state of exitus: group 1, those who did not survive; 33 patients, 19 males; 68.3 ± 11.8 years and group 2, those who survived; 117 patients, 68 males; 59.7 ± 13.8 years. Results:In all patients, the exitus rate was 22%, the rate of intensive care follow-up was 46%, and the intubation rate was 37.3%.The Charlson Comorbidity Index scores were significantly higher in group 1 compared to group 2. Multivariate logistic regression analyses demonstrated that the Charlson Comorbidity Index score was an independent predictor of in-hospital mortality (odds ratio: 1.990, 95% CI: 1.314-3.015,P = .001).The cut-off value for the Charlson Comorbidity Index to predict in-hospital mortality was 5.5, with 81.8% sensitivity and 73.5% specificity. Conclusions:The Charlson Comorbidity Index score, which can be obtained at the time of admission, could be associated with the prognosis of coronavirus disease 2019 patients.Those with a Charlson Comorbidity Index score greater than 5.5 could be more associated with negative outcomes and mortality.
2019-20 coronavirus outbreak
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To determine the prevalence of comorbid conditions among acute non-traumatic general surgery patients. To assess the impact of comorbidity on outcomes and evaluate the effectiveness of using Charlson comorbidity index (CCI) in these patients.All acute non-traumatic general surgery patients admitted to King Saud Medical Complex, Riyadh, Saudi Arabia, between January 1, 2007 and December 31, 2007 were included (n=1296). Patient data were explored to record comorbidity, and the CCI score calculated. The length of hospital stay, post-operative complications and mortality were recorded as outcome measures. The outcomes in patients with comorbid conditions were compared with patients without comorbid conditions.We found one or more comorbid conditions in 31.9% (n=414) patients. The CCI score ranged from 1-8. All 3 outcome measures were recorded significantly higher in patients with comorbidity compared to patients with no comorbid condition; length of stay, 17.3 versus 10.6 days (p<0.0001), post-operative complications 46.3% versus 31% (p<0.0001), mortality 7.7% versus 4.4% (p<0.0001). Severe comorbidity as indicated by higher CCI score significantly correlated with length of stay, r=0.30 (p<0.0001) and mortality, r=0.2645 (p<0.0001). Overall risk of mortality was 1.81 times higher with comorbidity (odds ratio 1.81, 95% confidence interval 1.087-3.012, p=0.0182).Comorbidity caused increased hospital stay, post-operative complications, and mortality among acute non-traumatic general surgery patients. The CCI is a reliable comorbidity index, which can help in managing risks in surgical patients.
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Traditionally, advanced age has been considered a major factor for increased LOS and healthcare costs. However, recent studies suggest that comorbidity may have an equal, if not greater, effect on LOS and mortality as age in a variety of clinical scenarios. The elderly are the most rapidly growing part of the population in developed countries and pacemakers (PM) are commonly implanted in this population. In this retrospective study, we aimed to evaluate the impact of comorbidity on LOS and mortality, as compared to age, in patients undergoing new PM implantation. 257 elective and non-elective patients that underwent new PM implantation were included in the study. The median follow-up time was 20 (15-25) months. A Charlson comorbidity index (CCI) > 1 resulted to be a significant predictor for the excess of LOS, whereas age did not significantly predict excess of LOS. Elderly patients (age > 75 years) with low comorbidity burden (CCI < 1) showed no significant differences with regards to LOS and mortality when compared to younger patients. Considering the findings of our study, when considering patients for PM implantation, comorbidity burden rather than age should be the driving factor in the approach of indication of PM implantation.
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Excess mortality
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Hip Fracture
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Goal of study : to assess the Charlson comorbidity index in those suffering from chronic obstructive pulmonary disease (COPD). Materials and methods . 207 patients suffering from COPD smoking for a long period of time (the smoker index of 240 and time of smoking of 40 packs/years were enrolled into the study. SCORE risk charts were used for evaluation of cardiovascular risk. The respiratory function was evaluated by the multi-module unit of MasterLab/Jaeger type. Charlson comorbidity index was used to assess comorbidity. Results . Charlson comorbidity index made 4.49 ± 1.50 scores in the studied group, those with very high cardiovascular risk made 68.9%. The confident correlation has been found out between total cardiovascular risk and Charlson comorbidity index. Direct moderate correlation has been found out between comorbidity index and rates of packs/years. Confident correlations have been found between comorbidity index and VC (r = -0.39, p < 0.005), comorbidity index and RV (r = 0.46, p < 0.05).
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Abstract Objective Pneumonia is a common but serious illness that continues to present significant morbidity and mortality. Although the effect of severity at admission on outcome has been well reported, the role of comorbidity is still not widely understood. The Charlson Comorbidity Index measures comorbidity with a well-established history of predicting long-term outcome but its utility in pneumonia prognosis is still limited. Here, we use the Charlson Comorbidity Index and hospital surveillance data to investigate associations between comorbidities and in-hospital mortality due to community-acquired pneumonia.Results Among the 535 eligible adult patients (69.0% male, median [IQR] age, 79 [70-84] years), 100 (18.7%) acquired severe to extremely severe pneumonia. The median [IQR] CCI was 1[1-3]. Malignancy (129 of 535, 24.1%), chronic pulmonary diseases (113 of 535, 21.1%) and congestive heart failure (103 of 535, 19.3%) were frequent. Higher Charlson Comorbidity Index scores were associated with higher risk of in-hospital mortality (OR 1.28; 95% CI 1.07-1.53). These results support the inclusion of comorbid burden in predicting community-acquired pneumonia outcome.
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The use of a multidisciplinary clinical pathway (MCP) for patients with hip fracture tends to be more effective than usual care (UC). The aim of this study was to evaluate the effects of an MCP approach on time to surgery, length of stay, postoperative complications, and 30-day mortality, compared to UC.This multicenter retrospective cohort study included patients aged 50 years or older with a proximal hip fracture who underwent surgery in one of the 6 hospitals in the Limburg trauma region of the Netherlands in 2012. Data such as demographics, process outcome measures, and clinical outcome were collected.This study included a total of 1193 patients (665 and 528 patients in the MCP and UC groups, respectively). There were no differences in patient demographics present. Time to surgery was significantly shorter in the MCP compared to the UC group (19.2 vs 24.4 hours, P < .01). The mean length of stay was 10 versus 12 days (P < .01). In the MCP group, significantly lower rates of postoperative complications were observed and significantly more patients were institutionalized than in the UC group. Mortality within 30 days after admission was comparable between the groups (overall mortality 6%).An MCP approach is associated with reduced time to surgery, postoperative complications, and length of stay, without a significant difference in 30-day mortality. The institutionalization rate was significantly higher in the MCP group.
Hip Fracture
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Geriatric Trauma
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We examined trends in hip fracture incidence in Denmark from 1980 to 2014, trends in subsequent 1-year mortality, and the prognostic impact of sex, age, and comorbidity.This nationwide cohort study prospectively collected data from population-based Danish registries. We included 262,437 patients with incident hip fracture and assessed comorbidity using the Charlson Comorbidity Index (CCI).Despite slight increases in incidence rates (IRs) of hip fracture up to the mid-1990s, the annual IR decreased by 29% from 1980 to 2014 in women but remained stable in men. Decrease affected all age groups. IR decreased in patients without comorbidity but increased with increasing comorbidity (13% in patients with moderate and 510% in patients with very severe comorbidity). Adjusted mortality rate ratios (MRRs) following hip fracture in 2010-2014 compared with 1980-1984 were 0.68 (95% confidence interval [CI] = 0.65, 0.71) within 30 days and 0.63 (95% CI = 0.61, 0.66) within 31-365 days. The mortality decreased up to 40% irrespective of comorbidity. Compared with patients with no comorbidity, those with very severe comorbidity had adjusted MRRs of 2.48 (95% CI = 2.39, 2.56) and 2.81 (95% CI = 2.74, 2.88) within 30 days and 31-365 days post-hip fracture, respectively.Although the incidence rate of hip fracture increased substantially with increasing comorbidity, the following 1-year mortality decreased by 40% from 1980 through 2014 irrespective of sex, age, and comorbidity level, suggesting improvement in both treatment and rehabilitation of patients with hip fracture. Comorbidity burden was, however, a strong prognostic factor for 1-year mortality after hip fracture.
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This study evaluates the role of the number of secondary diagnoses for calculating the Charlson comorbidity index (CCI) in risk adjustment of the 90-day mortality rate after hip fracture surgical repair. Comorbidities were selected by reviewing the medical records of 390 patients 50 years of age or older in a teaching hospital in Rio de Janeiro from 1995 to 2000. Logistic regression models were fitted including the variables age, sex, and CCI. The CCI was calculated based on: (1) all patients' comorbidities; (2) only the comorbidity with the highest weight; and (3) a single randomly selected comorbidity. There was a gradient in the prediction of the CCI mortality rate when all comorbidities were used (OR = 6.53; 95%CI: 2.27-18.77, for scores >or= 3). The predictive capacity of the CCI was observed even when it was calculated using only one comorbidity: with the highest weight (OR = 2.83; 95%CI: 1.11-7.22); and randomly selected (OR = 2.90; 95%CI: 1.07-7.81). Using all comorbidities for CCI calculation is important. Severity indices based on a single comorbidity can be useful for risk adjustment procedures.
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Purpose To characterize the impact of comorbidity on survival outcomes for patients with nasopharyngeal carcinoma (NPC) post radiotherapy (RT). Methods A total of 4095 patients with NPC treated by RT or RT plus chemotherapy (CT) in the period from 2007 to 2011 were included through Taiwan's National Health Insurance Research Database. Information on comorbidity present prior to the NPC diagnosis was obtained and adapted to the Charlson Comorbidity Index (CCI), Age-Adjusted Charlson Comorbidity Index (ACCI) and a revised head and neck comorbidity index (HN-CCI). The prevalence of comorbidity and the influence on survival were calculated and analyzed. Results Most of the patients (75%) were male (age 51±13 years) and 2470 of them (60%) had at least one comorbid condition. The most common comorbid condition was diabetes mellitus. According to these three different comorbidity index (CCI, ACCI and HN-CCI), higher scores were associated with worse overall survival (P< 0.001). The Receiver Operating Characteristic (ROC) curve was used to assess the discriminating ability of CCI, AACI and HN-CCI scores and it demonstrated the predictive ability for mortality with the ACCI (0.693, 95% CI 0.670–0.715) was superior to that of the CCI (0.619, 95% CI 0.593–0.644) and HN-CCI (0.545, 95%CI 0.519–0.570). Conclusion Comorbidities greatly influenced the clinical presentations, therapeutic interventions, and outcomes of patients with NPC post RT. Higher comorbidity index scores accurately was associated with worse survival. The ACCI seems to be a more appropriate prognostic indicator and should be considered in further clinical studies.
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