Browsing by Author "Radinovic, Kristina (55991237900)"

Background: Hip fractures in the elderly are followed by increased mortality, which is highest in the period immediately after the fracture. Predictors for early mortality have neither been well identified nor summarized. Identification of early postoperative mortality predictors enables the stratification of high-risk patients and can help in the development of strategies aimed at reducing risk and improving outcome after hip fracture. The primary aim of this study was to investigate the incidence of 30-day mortality. The secondary aim was to investigate factors related to early mortality. Methods: We examined 384 elderly patients with hip fracture. Multivariate logistic regression analysis was used to explore independent prognostic factors for 30-day mortality. Results: By the end of the 30-day follow-up period, 22 patients (6.4%) had died. Postoperative delirium was the only variable independently related to 30-day mortality after hip fracture. Older, male patients with a lower cognitive status had a higher chance of developing postoperative delirium. Discussion: Postoperative delirium is a strong independent marker of high risk for 30-day mortality. Older, male patients with more severe cognitive impairment are at increased risk of developing postoperative delirium. Identifying patients at risk for developing postoperative delirium upon admission and early detection of delirium enable the development of targeted prevention and intervention strategies in older patients with hip fracture. Psychogeriatrics © 2014 Japanese Psychogeriatric Society.

Background: Hip fractures in the elderly are followed by increased mortality, which is highest in the period immediately after the fracture. Predictors for early mortality have neither been well identified nor summarized. Identification of early postoperative mortality predictors enables the stratification of high-risk patients and can help in the development of strategies aimed at reducing risk and improving outcome after hip fracture. The primary aim of this study was to investigate the incidence of 30-day mortality. The secondary aim was to investigate factors related to early mortality. Methods: We examined 384 elderly patients with hip fracture. Multivariate logistic regression analysis was used to explore independent prognostic factors for 30-day mortality. Results: By the end of the 30-day follow-up period, 22 patients (6.4%) had died. Postoperative delirium was the only variable independently related to 30-day mortality after hip fracture. Older, male patients with a lower cognitive status had a higher chance of developing postoperative delirium. Discussion: Postoperative delirium is a strong independent marker of high risk for 30-day mortality. Older, male patients with more severe cognitive impairment are at increased risk of developing postoperative delirium. Identifying patients at risk for developing postoperative delirium upon admission and early detection of delirium enable the development of targeted prevention and intervention strategies in older patients with hip fracture. Psychogeriatrics © 2014 Japanese Psychogeriatric Society.

Aim: We aimed to evaluate the factors contributing to delirium after hip fracture and assess the effect of incident delirium on short-term clinical outcomes. Methods: A total of 270 non-delirious, consecutive hip fracture patients 60 years and older were included in a prospective cohort study. The patients were assessed with respect to physical status according to the American Society of Anesthesiologists classification, medical comorbidities with the Charlson Comorbidity Index, cognitive function with the Portable Mental Status Questionnaire and depression with the Geriatric Depressive Scale. Incident delirium was evaluated daily. Clinical outcomes and 1-month mortality were recorded. Results: Incident delirium was present in 53.0% of patients. Patients with delirium were older (P=0.046), had higher American Society of Anesthesiologists and Charlson Comorbidity Index scores (P<0.001), lower Portable Mental Status Questionnaire scores and higher Geriatric Depressive Scale scores (P<0.001, P=0.003, respectively). After adjusting for age, multivariate regression analysis in the first model showed that patients with delirium were at higher risk of reintervention plus death (P<0.05), complications P<0.001), a higher severity complication score (P<0.05) and longer length of hospital stay (P<0.001). In the second model, after adjusting for propensity score, patients with delirium were at higher risk of reintervention plus death (P<0.05) and longer length of hospital stay (P<0.01). Conclusions: Patients who are older, with worse physical status, worse cognitive function and depression are more likely to develop delirium after hip fracture. Incident delirium has negative independent effects on short-term outcomes in elderly patients after hip fracture. © 2014 Japan Geriatrics Society.

Aim: We aimed to evaluate the factors contributing to delirium after hip fracture and assess the effect of incident delirium on short-term clinical outcomes. Methods: A total of 270 non-delirious, consecutive hip fracture patients 60 years and older were included in a prospective cohort study. The patients were assessed with respect to physical status according to the American Society of Anesthesiologists classification, medical comorbidities with the Charlson Comorbidity Index, cognitive function with the Portable Mental Status Questionnaire and depression with the Geriatric Depressive Scale. Incident delirium was evaluated daily. Clinical outcomes and 1-month mortality were recorded. Results: Incident delirium was present in 53.0% of patients. Patients with delirium were older (P=0.046), had higher American Society of Anesthesiologists and Charlson Comorbidity Index scores (P<0.001), lower Portable Mental Status Questionnaire scores and higher Geriatric Depressive Scale scores (P<0.001, P=0.003, respectively). After adjusting for age, multivariate regression analysis in the first model showed that patients with delirium were at higher risk of reintervention plus death (P<0.05), complications P<0.001), a higher severity complication score (P<0.05) and longer length of hospital stay (P<0.001). In the second model, after adjusting for propensity score, patients with delirium were at higher risk of reintervention plus death (P<0.05) and longer length of hospital stay (P<0.01). Conclusions: Patients who are older, with worse physical status, worse cognitive function and depression are more likely to develop delirium after hip fracture. Incident delirium has negative independent effects on short-term outcomes in elderly patients after hip fracture. © 2014 Japan Geriatrics Society.

Aim: Postoperative delirium (PD) is a frequent complication of hip fracture surgery, but its pathophysiology remains poorly understood. We investigated the impact of a single episode of intraoperative hyper/hypotension, blood pressure (BP) fluctuation (ΔMAP), and pulse pressure (PP) on hyper/hypoactive PD in elderly patients undergoing surgery for hip fracture. We also assessed the effect of PD on clinical outcomes. Methods: This was a prospective 1-year follow-up study of patients over 60 years of age with a primary diagnosis of acute low-energy hip fracture. Perioperative delirium was assessed using the Confusion Assessment Method (CAM); the development of PD and the type, hyperactive or hypoactive PD, were recorded. Cognitive assessment was evaluated using the Short Portable Mental Status Questionnaire (SPMSQ). The lowest and highest BP values were extracted from the patients’ anaesthesia charts. Postoperative complications, reinterventions and 1-month mortality were recorded. Results: PD occurred in 148 (53%) patients during the first postoperative week, with 75% of the cases diagnosed as hypoactive PD. Patients developing PD of any type were older, had a lower body mass index, higher SPMSQ and Charlson scores, more severe systemic diseases, a lower lowest intraoperative BP, a higher ΔMAP, a lower PP, and a higher postoperative pain score. They also took more drugs and received more blood transfusion intraoperatively. Multivariate logistic regression analyses showed that a higher MAP min had a protective effect on the occurrence of any type of PD, as well as hypoactive and hyperactive. PD had negative effect on outcomes. Conclusion: Our results provide evidence of an association between maximal hypotension, the lowest intraoperative mean blood pressure (MAP), ΔMAP, PP, and PD. A progressive decrease in MAP during surgery was associated with the increased odds of developing either type of PD. © 2019 Elsevier Ltd

Introduction The aim of this study was to identify risk factors for severe postoperative pain immediately after hip-fracture surgery. Patients and methods Three hundred forty-four elderly patients with an acute hip fracture were admitted to the hospital during a 12-months period. All patients who entered the study answered a structured questionnaire to assess demographic characteristics, previous diseases, drug use, previous surgery, and level of education. Physical status was assessed through the American Society of Anesthesiologists' preoperative risk classification, cognitive status using the Short Portable Mental Status Questionnaire, and depression using the Geriatric Depression Scale. The presence of preoperative delirium using the Confusion Assessment Method was assessed during day and night shifts until surgery. Pain was measured using a numeric rating scale (NRS). An NRS ≥7 one hour after surgery indicated severe pain. Results Patients with elementary-level education (8 yr in school) presented a higher risk for immediate severe postoperative pain than university-educated patients (>12 yr in school) (P < 0.05). Higher cognitive function was associated with higher postoperative pain (P < 0.01). Patients with symptoms of depression and patients with preoperative delirium presented a higher risk for severe pain (P < 0.05, P < 0.01, respectively). Multivariate analysis showed that depression and a low level of education were independent predictors of severe pain immediately after surgery. Conclusion Depression and lower levels of education were independent predictors of immediate severe pain following hip-fracture surgery. These predictors could be clinically used to stratify analgesic risk in elderly patients for more aggressive pain treatment immediately after surgery. © 2014 Elsevier Ltd.

Introduction: The aims of this study were (1) to assess the incidence of ventilator-associated pneumonia (VAP) in patients with traumatic brain injury (TBI), (2) to identify risk factors for developing VAP, and (3) to assess the prevalence of the pathogens responsible. Patients and methods: The following data were collected prospectively from patients admitted to a 24-bed intensive care unit (ICU) during 2013/14: the mechanism of injury, trauma distribution by system, the Acute Physiology and Chronic Health Evaluation (APACHE) II score, the Abbreviated Injury Scale (AIS) score, the Injury Severity Score (ISS), underlying diseases, Glasgow Coma Scale (GCS) score, use of vasopressors, need for intubation or cardiopulmonary resuscitation upon admission, and presence of pulmonary contusions. All patients were managed with a standardized protocol if VAP was suspected. The Sequential Organ Failure Assessment (SOFA) score and the Clinical Pulmonary Infection Score (CPIS) were measured on the day of VAP diagnosis. Results: Of the 144 patients with TBI who underwent mechanical ventilation for >48h, 49.3% did not develop VAP, 24.3% developed early-onset VAP, and 26.4% developed late-onset VAP. Factors independently associated with early-onset VAP included thoracic injury (odds ratio (OR) 8.56, 95% confidence interval (CI) 2.05-35.70; p=0.003), ISS (OR 1.09, 95% CI 1.03-1.15; p=0.002), and coma upon admission (OR 13.40, 95% CI 3.12-57.66; p<0.001). Age (OR 1.04, 95% CI 1.02-1.07; p=0.002), ISS (OR 1.09, 95% CI 1.04-1.13; p<0.001), and coma upon admission (OR 3.84, 95% CI 1.44-10.28; p=0.007) were independently associated with late-onset VAP (Nagelkerke r2=0.371, area under the curve (AUC) 0.815, 95% CI 0.733-0.897; p<0.001). The 28-day survival rate was 69% in the non-VAP group, 45.7% in the early-onset VAP group, and 31.6% in the late-onset VAP group. Acinetobacter spp was the most common pathogen in patients with early- and late-onset VAP. Conclusions: These results suggest that the extent of TBI and trauma of other organs influences the development of early VAP, while the extent of TBI and age influences the development of late VAP. Patients with early- and late-onset VAP harboured the same pathogens. © 2015 The Authors.