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Pressure ulcers are associated with 6-month mortality in elderly patients with hip fracture managed in orthogeriatric care pathway

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Abstract

Summary

Despite orthogeriatric management, 12% of the elderly experienced PUs after hip fracture surgery. PUs were significantly associated with a low albumin level, history of atrial fibrillation coronary artery disease, and diabetes. The risk ratio of death at 6 months associated with pressure ulcer was 2.38 (95% CI 1.31–4.32%, p = 0.044).

Introduction

Pressure ulcers in hip fracture patients are frequent and associated with a poor outcome. An orthogeriatric management, recommended by international guidelines in hip fracture patients and including pressure ulcer prevention and treatment, could influence causes and consequences of pressure ulcer. However, remaining factors associated with pressure ulcer occurrence and prognostic value of pressure ulcer in hip fracture patients managed in an orthogeriatric care pathway remain unknown.

Methods

From June 2009 to April 2015, all consecutive patients with hip fracture admitted to a unit for Post-operative geriatric care were evaluated for eligibility. Patients were included if their primary presentation was due to hip fracture and if they were ≥ 70 years of age. Patients were excluded in the presence of pathological fracture or if they were already hospitalized at the time of the fracture. In our unit, orthogeriatric principles are implemented, including a multi-component intervention to improve pressure ulcer prevention and management. Patients were followed-up until 6 months after discharge.

Results

Five hundred sixty-seven patients were included, with an overall 14.4% 6-month mortality (95% CI 11.6–17.8%). Of these, 67 patients (12%) experienced at least one pressure ulcer. Despite orthogeriatric management, pressure ulcers were significantly associated with a low albumin level (RR 0.90, 95% CI 0.84–0.96; p = 0.003) and history of atrial fibrillation (RR 1.91, 95% CI 1.05–3.46; p = 0.033), coronary artery disease (RR 2.16, 95% CI 1.17–3.99; p = 0.014), and diabetes (RR 2.33, 95% CI 1.14–4.75; p = 0.02). A pressure ulcer was associated with 6-month mortality (RR 2.38, 95% CI 1.31–4.32, p = 0.044).

Conclusion

In elderly patients with hip fracture managed in an orthogeriatric care pathway, pressure ulcer remained associated with poorly modifiable risk factors and long-term mortality.

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References

  1. Johnell O, Kanis JA (2006) An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporosis Int 17:1726–1733

    Article  CAS  Google Scholar 

  2. Kanis JA, Oden A, McCloskey H et al (2012) A systematic review of hip fracture incidence and probability of fracture worldwide. Osteoporos Int 23:2239–2256

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Karampampa K, Ahlbom A, Michaelsson K et al (2015) Declining incidence trends for hip fractures have not been accompanied by improvements in lifetime risk or post-fracture survival—a nationwide study of the Swedish population 60 years and older. Bone 78:55–61

    Article  PubMed  Google Scholar 

  4. Brauer CA, Coco-Perraillon M, Cutler DM et al (2009) Incidence and mortality of hip fractures in the United States. J Am Med Assoc 302:1573–1579

    Article  CAS  Google Scholar 

  5. Le Manach Y, Collins G, Bhandari M et al (2015) Outcomes after hip fracture surgery compared with elective total hip replacement. JAMA 314(11):1159–1166

    Article  PubMed  Google Scholar 

  6. Penrod JD, Litke A, Hawkes WG et al (2008) The association of race, gender, and comorbidity with mortality and function after hip fracture. J Gerontol A Biol Sci Med Sci 63(8):867–872

    Article  PubMed  PubMed Central  Google Scholar 

  7. Ireland AW, Kelly PJ, Cumming RG (2015) Total hospital stay for hip fracture: measuring the variations due to pre-fracture residence, rehabilitation, complications and comorbidities. BMC Health Serv Res 15:17

    Article  PubMed  PubMed Central  Google Scholar 

  8. Barrois B, Labalette C, Rousseau P et al (2008) A national prevalence study of pressure ulcers in French hospital inpatients. J Wound Care 17(9):373–378

    Article  CAS  PubMed  Google Scholar 

  9. Khor HM, Tan J, Saedon NI et al (2014) Determinants of mortality among older adults with pressure ulcers. Arch Gerontol Geriat 59(3):536–541

    Article  Google Scholar 

  10. VanGilder C, Amlung S, Harrison P et al (2009) Results of the 2008–2009 international pressure ulcer prevalence survey and a 3 year, acute care, unit-specific analysis. Ostomy Wound Manage 55:39–45

    PubMed  Google Scholar 

  11. Thompson D (2005) A critical review of the literature on pressure ulcer aetiology. J Wound Care 14:87–90

    Article  CAS  PubMed  Google Scholar 

  12. Baumgarten M, Margolis DJ, Orwig DL et al (2009) Pressure ulcers in elderly patients with hip fracture across the continuum of care. J Am Geriatr Soc 57(5):863–870

    Article  PubMed  PubMed Central  Google Scholar 

  13. Ireland AW, Kelly PJ, Cumming RG (2015) Risk factor profiles for early and delayed mortality after hip fracture: analyses of linked Australian Department of Veterans. Affairs databases. Injury 46(6):1028–1035

    Article  PubMed  Google Scholar 

  14. Kammerlander C, Roth T, Friedman SM et al (2010) Ortho-geriatric service a literature review comparing different models. Osteoporos Int 21(suppl 4):S637–S646

    Article  CAS  PubMed  Google Scholar 

  15. Prestmo A, Hagen G, Sletvold O et al (2015) Comprehensive geriatric care for patients with hip fractures: a prospective, randomised, controlled trial. Lancet 385(9978):1623–1633

    Article  PubMed  Google Scholar 

  16. Tschannen D, Bates O, Talsma A et al (2012) Patient specific and surgical characteristics in the development of pressure ulcers. Am J Crit Care 21:116–125

    Article  PubMed  Google Scholar 

  17. Boddaert J, Cohen-Bittan J, Khiami F et al (2014) Postoperative admission to a dedicated geriatric unit decreases mortality in elderly patients with hip fracture. PLoS One 9(1):e83795

    Article  PubMed  PubMed Central  Google Scholar 

  18. Langer G, Fink A (2014) Nutritional interventions for preventing and treating pressure ulcers. Cochrane Database Syst Rev 6:CD003216

    Google Scholar 

  19. Tian M, Gong X, Rath S et al (2016) Management of hip fractures in older people in Beijing: a retrospective audit and comparison with evidence-based guidelines and practice in the UK. Osteoporos Int 27(2):677–681

  20. The National Hip Fracture Database (2012) National Report 2012. (online). Available at :www.nhfd.co.uk. Accessed 15 Sept 2015

  21. Vidan M, Serra JA, Moreno C et al (2005) Efficacy of a comprehensive geriatric intervention in older patients hospitalized for hip fracture: a randomized, controlled trial. J Am Geriatr Soc 53:1476–1482

    Article  PubMed  Google Scholar 

  22. Moja L, Piatti A, Pecoraro V et al (2012) Timing matters in hip fracture surgery: patients operated within 48 hours have better outcomes. A meta-analysis and meta-regression of over 190 000 patients. PLoS One 7(10):e46175

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Qaseem A, Mir TP, Starkey M et al (2015) Clinical Guidelines Committee of the American College of Physicians. Risk assessment and prevention of pressure ulcers: a clinical practice guideline from the American College of Physicians. Ann Intern Med 162(5):359–369

    Article  PubMed  Google Scholar 

  24. Delmi M, Rapin CH, Bengoa JM et al (1990) Dietary supplementation in elderly patients with fractured neck of the femur. Lancet 335(8696):1013–1016

    Article  CAS  PubMed  Google Scholar 

  25. Uriz-Otano F, Uriz-Otano JI, Malafarina V (2016) Factors associated with short-term functional recovery in elderly people with a hip fracture. Influence of cognitive impairment. J Am Med Dir Assoc 16(3):215–220

    Article  Google Scholar 

  26. Freeman C, Todd C, Camilleri-Ferrante C et al (2002) Quality improvement for patients with hip fracture: experience from a multi-site audit. Qual Saf Health Care 11(3):239–245

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Lefaivre KA, Macadam SA, Davidson DJ et al (2009) Length of stay, mortality, morbidity and delay to surgery in hip fractures. J Bone Joint Surg Br 91:922–927

    Article  CAS  PubMed  Google Scholar 

  28. Baumgarten M, Rich SE, Shardell MD et al (2012) Care-related risk factors for hospital- acquired pressure ulcers in elderly adults with hip fracture. J Am Geriatr Soc 60:277–283

    Article  PubMed  PubMed Central  Google Scholar 

  29. Lindholm C, Sterner E, Romanelli M et al (2008) Hip fracture and pressure ulcers—the Pan-European pressure ulcer study—intrinsic and extrinsic risk factors. Int Wound J 5:315–328

    Article  PubMed  Google Scholar 

  30. Myers AH, Robinson EG, Van Natta ML et al (1991) Hip fracture among the elderly: factors associated with in-hospital mortality. Am J Epidemiol 134(10):1128–1137

    Article  CAS  PubMed  Google Scholar 

Download references

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Authors and Affiliations

  1. Department of Geriatrics, Unit of Perioperative Geriatric care (UPOG), Groupe Hospitalier (GH) Pitié-Salpêtrière – Charles Foix, Assistance Publique-Hôpitaux de Paris (APHP), 47-83 Boulevard de l’Hôpital, 75013, Paris, Ivry sur Seine, France

    Emmanuelle Magny, Helene Vallet, Judith Cohen-Bittan, Marc Verny & Jacques Boddaert

  2. Department of Anesthesiology and Critical Care, Groupe Hospitalier (GH) Pitié-Salpêtrière – Charles Foix, Assistance Publique-Hôpitaux de Paris (APHP), Paris, Ivry sur Seine, France

    Mathieu Raux

  3. Sorbonne Universités UPMC Univ Paris 06, DHU FAST, UMRS INSERM 1166, IHU ICAN, UMRS INSERM 1158, CNRS UMR 8256, Paris, France

    Mathieu Raux, Marc Verny, Bruno Riou & Jacques Boddaert

  4. Department of Rehabilitation, Groupe Hospitalier (GH) Pitié-Salpêtrière – Charles Foix, Assistance Publique-Hôpitaux de Paris (APHP), Paris, Ivry sur Seine, France

    Antony Meziere

  5. Department of Emergency Medicine and Surgery, Groupe Hospitalier (GH) Pitié-Salpêtrière – Charles Foix, Assistance Publique-Hôpitaux de Paris (APHP), Paris, Ivry sur Seine, France

    Bruno Riou

  6. Department of Orthopedic Surgery and Trauma, Groupe Hospitalier (GH) Pitié-Salpêtrière – Charles Foix, Assistance Publique-Hôpitaux de Paris (APHP), Paris, Ivry sur Seine, France

    Frédéric Khiami

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  1. Emmanuelle Magny
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  2. Helene Vallet
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  3. Judith Cohen-Bittan
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  4. Mathieu Raux
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  8. Frédéric Khiami
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  9. Jacques Boddaert
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Correspondence to Jacques Boddaert.

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Magny, E., Vallet, H., Cohen-Bittan, J. et al. Pressure ulcers are associated with 6-month mortality in elderly patients with hip fracture managed in orthogeriatric care pathway. Arch Osteoporos 12, 77 (2017). https://doi.org/10.1007/s11657-017-0365-9

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