Adverse outcomes following pelvic fracture: the critical role of frailty.
Failure-to-rescue
Frailty
Geriatric patients
Morbidity
Mortality
Pelvic fracture
Journal
European journal of trauma and emergency surgery : official publication of the European Trauma Society
ISSN: 1863-9941
Titre abrégé: Eur J Trauma Emerg Surg
Pays: Germany
ID NLM: 101313350
Informations de publication
Date de publication:
29 Aug 2023
29 Aug 2023
Historique:
received:
05
06
2023
accepted:
21
08
2023
medline:
30
8
2023
pubmed:
30
8
2023
entrez:
29
8
2023
Statut:
aheadofprint
Résumé
Pelvic fractures among older adults are associated with an increased risk of adverse outcomes, with frailty likely being a contributing factor. The current study endeavors to describe the association between frailty, measured using the Orthopedic Frailty Score (OFS), and adverse outcomes in geriatric pelvic fracture patients. All geriatric (65 years or older) patients registered in the 2013-2019 Trauma Quality Improvement Program database with an isolated pelvic fracture following blunt trauma were considered for inclusion. An isolated pelvic fracture was defined as any fracture in the pelvis with a lower extremity AIS ≥ 2, any abdomen AIS, and an AIS ≤ 1 in all other regions. Poisson regression models were employed to determine the association between the OFS and adverse outcomes. A total of 66,404 patients were included for further analysis. 52% (N = 34,292) were classified as non-frail (OFS 0), 32% (N = 21,467) were pre-frail (OFS 1), and 16% (N = 10,645) were classified as frail (OFS ≥ 2). Compared to non-frail patients, frail patients exhibited a 88% increased risk of in-hospital mortality [adjusted IRR (95% CI): 1.88 (1.54-2.30), p < 0.001], a 25% increased risk of complications [adjusted IRR (95% CI): 1.25 (1.10-1.42), p < 0.001], a 56% increased risk of failure-to-rescue [adjusted IRR (95% CI): 1.56 (1.14-2.14), p = 0.006], and a 10% increased risk of ICU admission [adjusted IRR (95% CI): 1.10 (1.02-1.18), p = 0.014]. Frail pelvic fracture patients suffer from a disproportionately increased risk of mortality, complications, failure-to-rescue, and ICU admission. Additional measures are required to mitigate adverse events in this vulnerable patient population.
Identifiants
pubmed: 37644193
doi: 10.1007/s00068-023-02355-0
pii: 10.1007/s00068-023-02355-0
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2023. The Author(s).
Références
United Nations Department of Economic and Social Affairs, Population Division. World Population Ageing 2020 Highlights: Living arrangements of older persons [Internet]. New York, USA: United Nations Department of Economic and Social Affairs; 2020. Available from: https://www.un.org/development/desa/pd/sites/www.un.org.development.desa.pd/files/undesa_pd-2020_world_population_ageing_highlights.pdf
Wang X-Q, Chen P-J. Population ageing challenges health care in China. Lancet Lond Engl. 2014;383:870.
doi: 10.1016/S0140-6736(14)60443-8
Lancet T. Ageing well: a global priority. The Lancet. 2012;379:1274.
doi: 10.1016/S0140-6736(12)60518-2
Nanninga GL, de Leur K, Panneman MJM, van der Elst M, Hartholt KA. Increasing rates of pelvic fractures among older adults: the Netherlands, 1986–2011. Age Ageing. 2014;43:648–53.
pubmed: 24419459
doi: 10.1093/ageing/aft212
Behanova M, Haschka J, Reichardt B, Dimai H-P, Resch H, Zwerina J, et al. Pelvic fractures—An underestimated problem? Incidence and mortality risk after pelvic fracture in Austria, 2010–2018. J Clin Med. 2022;11:2834.
pubmed: 35628960
pmcid: 9146576
doi: 10.3390/jcm11102834
Clement ND, Court-Brown CM. Elderly pelvic fractures: the incidence is increasing and patient demographics can be used to predict the outcome. Eur J Orthop Surg Traumatol. 2014;24:1431–7.
pubmed: 24664452
doi: 10.1007/s00590-014-1439-7
Reito A, Kuoppala M, Pajulammi H, Hokkinen L, Kyrölä K, Paloneva J. Mortality and comorbidity after non-operatively managed, low-energy pelvic fracture in patients over age 70: a comparison with an age-matched femoral neck fracture cohort and general population. BMC Geriatr. 2019;19:315.
pubmed: 31744463
pmcid: 6862845
doi: 10.1186/s12877-019-1320-y
Ramser M, Vach W, Strub N, Cadosch D, Saxer F, Eckardt H. The impact of specific fracture characteristics of low-energy fractures of the pelvis on mortality. BMC Geriatr. 2022;22:669.
pubmed: 35971065
pmcid: 9377136
doi: 10.1186/s12877-022-03223-z
Banierink H, ten Duis K, de Vries R, Wendt K, Heineman E, Reininga I, et al. Pelvic ring injury in the elderly: Fragile patients with substantial mortality rates and long-term physical impairment. PLoS One. 2019;14: e0216809.
pubmed: 31136589
pmcid: 6538139
doi: 10.1371/journal.pone.0216809
Oberkircher L, Ruchholtz S, Rommens PM, Hofmann A, Bücking B, Krüger A. Osteoporotic pelvic fractures. Dtsch Arzteblatt Int. 2018;115:70–80.
Hill RMF, Robinson CM, Keating JF. Fractures of the pubic rami: epidemiology and five-year survival. J Bone Joint Surg Br. 2001;83:1141–4.
pubmed: 11764428
doi: 10.1302/0301-620X.83B8.0831141
Mears SC, Berry DJ. Outcomes of displaced and nondisplaced pelvic and sacral fractures in elderly adults. J Am Geriatr Soc. 2011;59:1309–12.
pubmed: 21718260
doi: 10.1111/j.1532-5415.2011.03455.x
Gundel O, Thygesen LC, Gögenur I, Ekeloef S. Postoperative mortality after a hip fracture over a 15-year period in Denmark: a national register study. Acta Orthop. 2020;91:58–62.
pubmed: 31635502
doi: 10.1080/17453674.2019.1680485
Smith CT, Barton DW, Piple AS, Carmouche JJ. Pelvic fragility fractures: an opportunity to improve the undertreatment of osteoporosis. J Bone Joint Surg Am. 2021;103:213–8.
pubmed: 33269895
doi: 10.2106/JBJS.20.00738
Joseph B, Pandit V, Sadoun M, Zangbar B, Fain MJ, Friese RS, et al. Frailty in surgery. J Trauma Acute Care Surg. 2014;76:1151–6.
pubmed: 24662884
doi: 10.1097/TA.0000000000000103
Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet Lond Engl. 2013;381:752–62.
doi: 10.1016/S0140-6736(12)62167-9
Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I, et al. A global clinical measure of fitness and frailty in elderly people. CMAJ Can Med Assoc J. 2005;173:489–95.
doi: 10.1503/cmaj.050051
Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56:M146-156.
pubmed: 11253156
doi: 10.1093/gerona/56.3.M146
Perea LL, Fort LS, Morgan ME, Brown CT, Wang S, Bradburn E. Frailty is associated with worse outcomes in geriatric pelvic fractures. Am Surg. 2022;88:1573–5.
pubmed: 35337207
doi: 10.1177/00031348221084943
Ravindrarajah R, Hazra NC, Charlton J, Jackson SHD, Dregan A, Gulliford MC. Incidence and mortality of fractures by frailty level over 80 years of age: cohort study using UK electronic health records. BMJ Open. 2018;8: e018836.
pubmed: 29358434
pmcid: 5781050
doi: 10.1136/bmjopen-2017-018836
Kelsey JL, Prill MM, Keegan THM, Quesenberry CP, Sidney S. Risk factors for pelvis fracture in older persons. Am J Epidemiol. 2005;162:879–86.
pubmed: 16221810
doi: 10.1093/aje/kwi295
WMA - The World Medical Association-WMA Declaration of Helsinki – Ethical Principles for Medical Research Involving Human Subjects. Available from: https://www.wma.net/policies-post/wma-declaration-of-helsinki-ethical-principles-for-medical-research-involving-human-subjects/
Forssten MP, Cao Y, Trivedi DJ, Ekestubbe L, Borg T, Bass GA, et al. Developing and validating a scoring system for measuring frailty in patients with hip fracture: a novel model for predicting short-term postoperative mortality. Trauma Surg Acute Care Open. 2022;7: e000962.
pubmed: 36117728
pmcid: 9472206
doi: 10.1136/tsaco-2022-000962
Forssten MP, Mohammad Ismail A, Ioannidis I, Wretenberg P, Borg T, Cao Y, et al. The mortality burden of frailty in hip fracture patients: a nationwide retrospective study of cause-specific mortality. Eur J Trauma Emerg Surg Off Publ Eur Trauma Soc. 2022;49(3):1467–75.
doi: 10.1007/s00068-022-02204-6
Mansournia MA, Nazemipour M, Naimi AI, Collins GS, Campbell MJ. Reflection on modern methods: demystifying robust standard errors for epidemiologists. Int J Epidemiol. 2021;50:346–51.
pubmed: 33351919
doi: 10.1093/ije/dyaa260
R Development Core Team. R: A language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing; 2008. Available from: http://www.R-project.org/
Bhattacharya B, Maung A, Schuster K, Davis KA. The older they are the harder they fall: injury patterns and outcomes by age after ground level falls. Injury. 2016;47:1955–9.
pubmed: 27346422
doi: 10.1016/j.injury.2016.06.019
Bergh C, Wennergren D, Möller M, Brisby H. Fracture incidence in adults in relation to age and gender: a study of 27,169 fractures in the Swedish Fracture Register in a well-defined catchment area. PLoS One. 2020;15: e0244291.
pubmed: 33347485
pmcid: 7751975
doi: 10.1371/journal.pone.0244291
Rogers M, Brown R, Stanger S. Frailty in orthopaedics: is age relevant? Injury. 2020;51:2402–6.
pubmed: 32718751
pmcid: 7361099
doi: 10.1016/j.injury.2020.07.031
Mamtora PH, Fortier MA, Barnett SR, Schmid LN, Kain ZN. Peri-operative management of frailty in the orthopedic patient. J Orthop. 2020;22:304–7.
pubmed: 32616993
pmcid: 7322091
doi: 10.1016/j.jor.2020.05.024
Kane RL, Switzer JA, Forte ML. Rethinking orthopaedic decision-making for frail patients with hip fracture: commentary on an article by Marilyn Heng, MD, FRCSC, et al.: Abnormal Mini-Cog is associated with higher risk of complications and delirium in geriatric patients with fracture. JBJS. 2016;98: e39.
doi: 10.2106/JBJS.15.01437
Küper MA, Trulson A, Stuby FM, Stöckle U. Pelvic ring fractures in the elderly. EFORT Open Rev. 2019;4:313–20.
pubmed: 31312519
pmcid: 6598730
doi: 10.1302/2058-5241.4.180062
Rodriguez JA Jr, Shahi A, Mashru RP, Graf KW Jr. Review of the literature and surgeon’s opinion: pelvic fractures in the geriatric population. To fix or not to fix? Gerontol Geriatr Med. 2021;7:1–7.
Sabharwal S, Wilson H. Orthogeriatrics in the management of frail older patients with a fragility fracture. Osteoporos Int. 2015;26:2387–99.
pubmed: 25986384
doi: 10.1007/s00198-015-3166-2
American College of Surgeons. ACS TQIP geriatric trauma management guidelines. 2013. Available from: https://www.facs.org/media/314or1oq/geriatric_guidelines.pdf
Van Heghe A, Mordant G, Dupont J, Dejaeger M, Laurent MR, Gielen E. Effects of orthogeriatric care models on outcomes of hip fracture patients: a systematic review and meta-analysis. Calcif Tissue Int. 2022;110:162–84.
pubmed: 34591127
doi: 10.1007/s00223-021-00913-5
Moyet J, Deschasse G, Marquant B, Mertl P, Bloch F. Which is the optimal orthogeriatric care model to prevent mortality of elderly subjects post hip fractures? A systematic review and meta-analysis based on current clinical practice. Int Orthop. 2019;43:1449–54.
pubmed: 29691612
doi: 10.1007/s00264-018-3928-5
Grigoryan KV, Javedan H, Rudolph JL. Orthogeriatric care models and outcomes in hip fracture patients: a systematic review and meta-analysis. J Orthop Trauma. 2014;28:e49-55.
pubmed: 23912859
pmcid: 3909556
doi: 10.1097/BOT.0b013e3182a5a045
Pean CA, Thomas HM, Singh UM, DeBaun MR, Weaver MJ, von Keudell AG. Use of a six-item modified frailty index to predict 30-day adverse events, readmission, and mortality in older patients undergoing surgical fixation of lower extremity, pelvic, and acetabular fractures. JAAOS Glob Res Rev. 2023;7: e22.00286.
doi: 10.5435/JAAOSGlobal-D-22-00286
Roopsawang I, Zaslavsky O, Thompson H, Aree-Ue S, Kwan RYC, Belza B. Frailty measurements in hospitalised orthopaedic populations age 65 and older: a scoping review. J Clin Nurs. 2021. https://doi.org/10.1111/jocn.16035 .
doi: 10.1111/jocn.16035
pubmed: 34622525
pmcid: 9293223
Cooper Z, Rogers SO, Ngo L, Guess J, Schmitt E, Jones RN, et al. A comparison of frailty measures as predictors of outcomes after orthopedic surgery. J Am Geriatr Soc. 2016;64:2464–71.
pubmed: 27801939
pmcid: 5173406
doi: 10.1111/jgs.14387
Zaslavsky O, Zelber-Sagi S, Gray SL, LaCroix AZ, Brunner RL, Wallace RB, et al. A comparison of frailty phenotypes for prediction of mortality, incident falls, and hip fractures in older women. J Am Geriatr Soc. 2016;64:1858–62.
pubmed: 27310179
pmcid: 5026871
doi: 10.1111/jgs.14233
Mendiratta P, Schoo C, Latif R. Clinical frailty scale. StatPearls. Treasure Island (FL): StatPearls Publishing; 2023. http://www.ncbi.nlm.nih.gov/books/NBK559009/
Theou O, Pérez-Zepeda MU, van der Valk AM, Searle SD, Howlett SE, Rockwood K. A classification tree to assist with routine scoring of the Clinical Frailty Scale. Age Ageing. 2021;50:1406–11.
pubmed: 33605412
pmcid: 7929455
doi: 10.1093/ageing/afab006
Young RL, Smithard DG. The clinical frailty scale: Do staff agree? Geriatr Basel Switz. 2020;5:40.
doi: 10.3390/geriatrics5020040
Shrier W, Dewar C, Parrella P, Hunt D, Hodgson LE. Agreement and predictive value of the Rockwood Clinical Frailty Scale at emergency department triage. Emerg Med J EMJ. 2021;38:868–73.
pubmed: 33172880
doi: 10.1136/emermed-2019-208633
Pugh RJ, Battle CE, Thorpe C, Lynch C, Williams JP, Campbell A, et al. Reliability of frailty assessment in the critically ill: a multicentre prospective observational study. Anaesthesia. 2019;74:758–64.
pubmed: 30793278
doi: 10.1111/anae.14596
Clegg A, Bates C, Young J, Ryan R, Nichols L, Ann Teale E, et al. Development and validation of an electronic frailty index using routine primary care electronic health record data. Age Ageing. 2016;45:353–60.
pubmed: 26944937
pmcid: 4846793
doi: 10.1093/ageing/afw039
Elixhauser A, Steiner C, Harris DR, Coffey RM. Comorbidity measures for use with administrative data. Med Care. 1998;36:8–27.
pubmed: 9431328
doi: 10.1097/00005650-199801000-00004