Does preoperative hemodynamic preconditioning improve morbidity and mortality after traumatic hip fracture in geriatric
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TRAUMA SURGERY
Does preoperative hemodynamic preconditioning improve morbidity and mortality after traumatic hip fracture in geriatric patients? A retrospective cohort study J. Q. Kusen1 · P. C. R. van der Vet1 · F. J. G. Wijdicks3 · B. C. Link1 · B. Poblete2 · D. van der Velde4 · R. Babst1 · F. J. P. Beeres1 Received: 22 March 2020 / Accepted: 9 September 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Introduction Dehydration is a major problem in the older population with traumatic hip fractures (THF). A preoperative hemodynamic preconditioning (PHP) protocol may help in achieving hemodynamic stability to ensure adequate perfusion and oxygenation using only clinical parameters to assess cardiovascular performance. Materials and methods A single-centre retrospective study in geriatric trauma patients was conducted in a Level 1 Trauma Centre in Switzerland. Patients over the age of 70 with THFs and with Portsmouth Physiological and Operative Severity Score for the enUmeration of Mortality (P-POSSUM) scores ≥ 5% who underwent surgical treatment between February 2015 and October 2017 were included. It was hypothesized that patients whose hemodynamic stability was optimised before surgery would have fewer complications and reduced mortality postoperatively. Primary outcomes were complications and mortality. Secondary outcomes were hospital length of stay (HLOS) and place of discharge. Results 100 patients were included in the PHP group and 79 patients were included in the non-PHP group. The median age was 86.5 (82–90) in the PHP group and 86 (82–90) in the non-PHP group. Patients who had been treated according to the PHP protocol showed a significant reduction in mortality at 30 days (p = 0.02). The PHP group showed an 8.1 and 3.5% reduced mortality at 90 days and at 1 year, respectively. The PHP group showed an 11.7% reduction of patients with complicated courses. No significant differences were seen in HLOS and discharge disposition. Conclusions The PHP group showed a significant reduction in short-term mortality, a reduction in long-term mortality, and a reduction in the number of patients with complicated courses. The PHP protocol is a safe, strictly regulated, non-invasive fluid resuscitation protocol for the optimization of geriatric patients with a THF that requires minimal effort. Level of evidence Level III, therapeutic Keywords Fluid resuscitation · Hip fracture · Geriatric · Perioperative fluids · Postoperative complications
Introduction
* F. J. P. Beeres [email protected] 1
Klinik für Orthopädie Und Unfallchirurgie, Luzerner Kantonsspital, Spitalstrasse, 6000 Lucerne, Switzerland
2
Klinik für Anästhesie, Luzerner Kantonsspital, Spitalstrasse, 6000 Lucerne, Switzerland
3
Department of Surgery, Diakonessenhuis, Utrecht, The Netherlands
4
Department of Surgery, St. Antoniusziekenhuis, Utrecht, The Netherlands
Frail, older patients have a reduced physiological capability to withstand a major trauma like a hip fracture [1]. Comorbidities and polypharma
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