Evaluation of a 30-day-mortality risk calculator for patients undergoing surgical fixation of fragility hip fractures.

INTRODUCTION: Hip fractures often occur in medically complex patients and can be associated with high perioperative mortality. Mortality risk assessment tools that are specific to hip fracture patients have not been extensively studied. The objective of this study is to evaluate a recently published 30-day mortality risk calculator (Hip Fracture Estimator of Mortality Amsterdam [HEMA]) in a group of patients treated at a university health system. MATERIALS & METHODS: 625 patients treated surgically for hip fractures between 2015 and 2020 at our institution were retrospectively reviewed. Patients younger than age 65, periprosthetic fractures, revision procedures, and fractures treated non-operatively were excluded. Univariate and multivariate analyses were used to determine significant relationships between variables and 30-day mortality after surgery. Additional patient-specific risk factors not included in the original risk calculator were also evaluated. RESULTS: The observed 30-day mortality was 5.6%. HEMA score was significantly associated with 30-mortality, though our cohort had significantly lower mortality rates in high-risk patients than expected based on the HEMA tool. In analyzing patient characteristics not included in HEMA score, history of dementia and elevated troponin were significantly associated with 30-day mortality. DISCUSSION: The HEMA score reliably stratifies risk for 30-day mortality after hip fracture, though overestimates mortality in high-risk patients treated at a tertiary care center with a multidisciplinary team. The HEMA score may be enhanced by considering additional variables, including troponin level and history of dementia. LEVEL OF EVIDENCE: IV.

Knee pain and crouch gait in individuals with cerebral palsy: what impact does crouch-related surgery have?

AIM: To investigate the effect of crouch-related surgery on knee pain in individuals with cerebral palsy. METHOD: We retrospectively identified individuals with two three-dimensional gait analyses at baseline and follow-up visits. All individuals walked in crouch gait at baseline. Visits were 9 months to 42 months apart. Baseline knee pain, age, crouch-related surgery (yes/no), and minimum knee flexion at follow-up were entered into a logistic regression to predict follow-up knee pain. RESULTS: Thirty-two individuals (21 males, 11 females; mean [SD] age 12y 10mo [2y 5mo]; 8y 1mo-18y 7mo) received crouch-related surgery, while 19 were managed non-surgically. At baseline, knee pain prevalence was 38% in the surgical group and 21% in the non-surgical group. At follow-up, 34% of the surgical group and 16% of the non-surgical group had knee pain (odds ratio: 2.809, p=0.285). INTERPRETATION: Crouch-related surgery does not appear to decrease knee pain prevalence compared to a comparison group, based on this preliminary study. Further investigation of the roles of these procedures is indicated with regards to this patient-reported outcome. What this paper adds Approximately 38% of individuals undergoing crouch-related surgery had knee pain. Approximately 42% of individuals with baseline knee pain who had surgery still had knee pain 1 year postoperatively. Approximately 50% of those with baseline knee pain managed non-surgically still had knee pain 1 year later. Crouch-related surgery tended not to decrease knee pain prevalence 1 year postoperatively.

Dolor de rodilla y marcha en cuclillas en personas con parálisis cerebral: ¿qué impacto tiene la cirugía indicadas para esta deformidad? OBJETIVO: Investigar el efecto de la cirugía relacionada con la marcha en cuclillas con el dolor de rodilla en personas con parálisis cerebral. MÉTODO: Identificamos retrospectivamente a los individuos con dos análisis tridimensionales de la marcha al inicio y en las visitas de seguimiento. Todos los individuos caminaron en cuclillas al inicio del estudio. Las visitas fueron de 9 a 42 meses de diferencia. El dolor al inicio, edad, la cirugía relacionada con este tipo de marcha (sí / no) y la flexión mínima de la rodilla en el seguimiento, se ingresaron en una regresión logística para predecir el dolor de rodilla de seguimiento. RESULTADOS: Treinta y dos individuos (21 varones, 11 mujeres; media [DE] edad 12 años 10 meses [2 años 5 meses]; 8 años 1 mes - 18 años 7 meses) recibieron cirugía para corregir esta alteración, mientras que 19 fueron manejados sin cirugía. Al inicio del estudio, la prevalencia del dolor de rodilla fue del 38% en el grupo quirúrgico y del 21 por ciento en el grupo no quirúrgico. En el seguimiento, el 34% del grupo quirúrgico y el 16% del grupo no quirúrgico tenían dolor de rodilla (odds ratio: 2,809, p = 0,285). INTERPRETACIÓN: Según este estudio preliminar, la cirugía relacionada para la marcha en cuclillas, no parece disminuir la prevalencia del dolor de rodilla en comparación con un grupo de comparación. Se sugiere una investigación adicional de las funciones de estos procedimientos con respecto a los resultados informados por pacientes.

Dor no joelho e marcha agachada em indivíduos com paralisia cerebral: qual o impacto da cirurgia relacionada à marcha agachada? OBJETIVO: Investigar o efeito de cirurgia relacionada à marcha agachada na dor no joelho de indivíduos com paralisia cerebral. MÉTODO: Identificamos retrospectivamente indivíduos com duas análises tridimensionais da marcha em visitas de linha de base e acompanhamento. Todos os indivíduos apresentavam marcha agachada na linha de base. As visitas tiveram de 9 a 42 meses de distância. A dor no joelho, idade, cirurgia relacionada à marcha agachada (sim/não) na linha de base, e flexão mínima do joelho no acompanhamento foram inseridas em uma regressão logístia para predizer a dor no joelho no acompanhamento. RESULTADOS: Trinta e dois indivíduos (21 do sexo masculino, 11 do sexo feminino; média [DP] de idade 12a 10m [2a 5m]; 8a 1m-18a 7m) receberam cirurgia relacionada à marcha agachada, enquanto 19 tiveram manejo não-cirúrgico. Na linha de base, a prevalência de dor no joelho era 38 por cento no grupo cirúrgico, e 21 por cento no grupo não-cirúrgico. No acompanhamento, 34 por cento do grupo cirúrgico e 16 por cento do grupo não cirúrgico tiveram dor no joelho (taxa de risco: 2,809, p=0,285). INTERPRETAÇÃO: A cirurgia relacionada à marcha agachada não parece diminuir a prevalência de dor no joelho em relação a um grupo de comparação, com base neste estudo preliminar. Mais investigações sobre o papel destes procedimentos são indicadas, com relação a este desfecho relatado pelos pacientes.

Musculoskeletal Involvement in SSc Is Associated with Worse Scores on Short Form-36 and Scleroderma Health Assessment Questionnaire and Lower Tumor Necrosis Factor-α Gene Expression in Peripheral Blood Mononuclear Cells.

BACKGROUND: Systemic sclerosis (SSc) is characterized by a wide variety of symptoms and disease manifestations including joint pain, gastrointestinal dysfunction, interstitial lung disease, and cardiomyopathy. QUESTIONS/PURPOSES: Using the Scleroderma Health Assessment Questionnaire (SHAQ) and Short Form-36 (SF-36) we explored how patient-reported physical health, mental health, and functional status related to these clinical characteristics and to cytokine levels utilizing the Hospital for Special Surgery Scleroderma Registry. METHODS: In a cross-sectional study of 185 patients meeting the 2013 ACR/EULAR criteria for SSc, we compared disease features and patient-reported outcomes (PROs). Interleukin-6 (IL-6), interleukin-1ß (IL1ß), and tumor necrosis factor-α (TNFα) levels were assessed by luminex and ELISA assays in a subset of 32 patients. The Pearson correlation coefficient, Spearman correlation coefficient, two-sample t test or Wilcoxon rank sum test, ANOVA or Kuskal-Wallis test, and Pearson chi-squared or Fisher's exact test were performed as applicable to detect the association between disease manifestations, PROs, and blood biomarkers. RESULTS: The modified Rodnan skin score (MRSS) was positively correlated with SHAQ scores. Patients who had musculoskeletal involvement scored worse on both the SHAQ and SF-36. Lower levels of TNFα expression in PBMCs were also correlated with musculoskeletal involvement. No other significant correlations were found between clinical factors, PROs, and cytokine data. CONCLUSION: Musculoskeletal outcomes are a major determinant of quality of life and function in patients with SSc. These results emphasize the importance of musculoskeletal outcomes in clinical studies of SSc.