Browsing by Subject "hip fracture"
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Item An Analysis of Osteoporosis-Related Hip Fractures, Using Hospital Discharge Data(2001-12-01) Rubin, Bernard; Antonio A. Rene; Douglas Mains; Muriel MarshallThe purpose of this study is to assess whether a current physician practice may inadequately diagnose osteoporosis in a high risk population of postmenopausal women who have sustained a hip fracture. A review of all patients discharged from Texas hospitals during calendar year 1999 was analyzed, using the Public Use Data File provided through the Texas Health Care Information Council. A total of 13,628 women over the age of 55 were admitted to hospital with a fractured hip. Only 2,233, or 16.3%, of women were also coded with the diagnosis of osteoporosis (P [less than] 0.001). Forty to fifty percent of postmenopausal women have osteoporosis. Therefore, women presenting with a fragility fracture form an even more at-risk subset of the population, such that one would expect a majority of these women to carry a diagnosis of osteoporosis. Percentages of Caucasian, non-Hispanic women in each group were comparable. The age distribution in each group was comparable, implying that the coded diagnosis of osteoporosis was not related to the age of the women when admitted to the hospital. In conclusion, physicians practicing in Texas during calendar year 1999 inadequately diagnosed osteoporosis in a high risk population of postmenopausal women who were admitted to hospital with fractured hip. Future analysis of subsequent analysis databases will be able to identify whether or not continuing medical education efforts will cause physicians to diagnose osteoporosis in this high risk population more frequently.Item Efficacy of Osteopathic Manipulative Treatment in Improving Clinical Outcomes in Patients with Orthopedic Diagnoses Admitted to a Hospital-Based Rehabilitation Unit(1997-06-01) Brittain, Paul D.; John LicciardoneBrittain, Paul D., Efficacy of Osteopathic Manipulative Treatment in Improving Clinical Outcomes in Patients with Orthopedic Diagnoses Admitted to a Hospital-Based Rehabilitation Unit Master of Public Health (Biomedical Sciences), June, 1997, 75 pp., 12 tables, bibliography, 16 titles. The primary purpose of this study was to determine the efficacy of osteopathic manipulative treatment (OMT) in improving clinical outcomes in patients who had undergone a surgical procedure for either a hip fracture or osteoarthritis affecting the hip or knee. OMT treatment subjects were recruited from an inpatient rehabilitation unit housed with an osteopathic hospital. OMT subjects received a standard course of OMT throughout their stay in the rehabilitation unit. Clinical outcomes were assessed principally through the administration of the Functional Independence Measure (FIM), a standard disability measure, to study subjects on admission to and discharge from the rehabilitation unit. Mean FIM score charges were compared between the OMT and a control group of similar patients. Receipt of OMT was associated with shorter length-of-stay, higher total FIM score change, and greater improvement on FIM locomotion items. These findings suggest that OMT is a beneficial therapy for this population of patients.Item Risk Factors Associated with Low Bone Mineral Density and Hip Fracture Among United States 20-90 Years of Age (NHANES III Study)(1999-06-01) Nandi, Shubhra; Antonio Rene; John Licciardone; Nelson C. FongNandi, Shubhra. Risk Factors Associated with Low Bone Mineral Diversity and Hip Fracture Among United States Females 20-29 Years of Age. (NHANES III Study). Master of Public Health, June 1999, 45p.p. Osteoporosis has become a great public health problem because of the growing segment of the elderly population. The manifestation of osteoporosis results in morbidity with disability and a diminished quality of life due to hip fracture and spine fracture. This is also the major cause of hospital expenditure. Thus, understanding the development of low bone mineral density at various skeletal sites and the prevention of the causes related to the diminished bone mineral density is of great importance. This is a descriptive study of risk factors associated with low bone mineral density and hip fracture among United States females 20-90 years of age. Data was collected by the National Center for Health Statistics from 1988-1994 in two phases. Several risk factors have been associated with low bone mineral density. They are age, race, body mass index, fat-free mass, smoking, alcohol intake, caffeine intake, calcium supplement intake, dairy intake, and the level of physical activity. The primary objective of this study was to elucidate the relationship of low bone mineral density in a specific race-ethnic population with the perceived risk factors. This cross-sectional study provides information to confirm that Non-Hispanic Whites have low bone mineral density at the end of their decade of life compared to Non-Hispanic Blacks and Hispanic Americans. A significant association between low bone mineral density and age, race ethnicity, body mass index, and milk intake was detected (P [less than] 0.05). Other factors did not display any statistically significant correlation.Item Shorter length of hospital stay for hip fracture in those with dementia and without a known diagnosis of osteoporosis in the USA(BioMed Central Ltd., 2020-12-03) Rasu, Rafia S.; Zalmai, Rana; Karpes Matusevich, Aliza R.; Hunt, Suzanne L.; Phadnis, Milind A.; Rianon, NahidBACKGROUND: About 50% of all hospitalized fragility fracture cases in older Americans are hip fractures. Approximately 3/4 of fracture-related costs in the USA are attributable to hip fractures, and these are mostly covered by Medicare. Hip fracture patients with dementia, including Alzheimer's disease, have worse health outcomes including longer hospital length of stay (LOS) and charges. LOS and hospital charges for dementia patients are usually higher than for those without dementia. Research describing LOS and acute care charges for hip fractures has mostly focused on these outcomes in trauma patients without a known pre-admission diagnosis of osteoporosis (OP). Lack of documented diagnosis put patients at risk of not having an appropriate treatment plan for OP. Whether having a diagnosis of OP would have an effect on hospital outcomes in dementia patients has not been explored. We aim to investigate whether having a diagnosis of OP, dementia, or both has an effect on LOS and hospital charges. In addition, we also report prevalence of common comorbidities in the study population and their effects on hospital outcomes. METHODS: We conducted a cross-sectional analysis of claims data (2012-2013) for 2175 Medicare beneficiaries (>/=65 years) in the USA. RESULTS: Compared to those without OP or dementia, patients with demenia only had a shorter LOS (by 5%; P = .04). Median LOS was 6 days (interquartile range [IQR]: 5-7), and the median hospital charges were $45,100 (IQR: 31,500 - 65,600). In general, White patients had a shorter LOS (by 7%), and those with CHF and ischemic heart disease (IHD) had longer LOS (by 7 and 4%, respectively). Hospital charges were 6% lower for women, and 16% lower for White patients. CONCLUSION: This is the first study evaluating LOS in dementia in the context of hip fracture which also disagrees with previous reporting about longer LOS in dementia patients. Patients with CHF and IHD remains at high risk for longer LOS regardless of their diagnosis of dementia or OP.Item THE EFFECT OF PREOPERATIVE TRANSTHORACIC ECHOCARDIOGRAM ON MORTALITY AND SURGICAL TIMING IN ELDERLY HIP FRACTURE PATIENTS(2014-03) Luttrell, Kevin; Nana, ArvindEchocardiograms are a noninvasive way to assess heart function in elderly patients prior to surgical treatment of hip fractures. Unfortunately testing delays surgical treatment, and intervention for heart disease is rarely performed based on echocardiogram findings. Our patient review demonstrated no benefit to mortality in patients tested with echocardiogram prior to surgical treatment of hip fractures with significant delay in surgical timing and subsequent increased length of hospital stay. Purpose (a): Heart disease is the most common cause of postoperative mortality in elderly hip fracture patients, and transthoracic echocardiogram (TTE) is often used to assess cardiac function prior to surgery. The purpose of our study was to evaluate the effect of preoperative TTE on mortality, postoperative complications, surgical timing, and length of stay in surgically treated hip fracture patients. Methods (b): A retrospective chart review was performed on 694 consecutive hip fracture patients >60 years of age treated surgically at two local hospitals. Patients were identified by billing codes over a 30 month time period from July 1st 2009 to December 31st 2011. Hospital records were reviewed for age, sex, timing of admission, medical clearance, operation and discharge, admitting service, fracture and treatment type, medical comorbidities, American Society of Anesthesiologists (ASA) score, preoperative testing ordered (TTE), preoperative cardiac intervention, complications, and mortality. The social security death index was used for thirty day and one year mortality data when not available in the hospital records. Our primary outcome measure was in-hospital, thirty day, and one year mortality following hip fracture surgery in patients that receive preoperative TTE. Secondary outcome measures included complications (particularly cardiovascular) and time required for medical clearance and operative treatment. Results (c): Preoperative echocardiogram was performed on 131 patients (18.9%). Patients admitted by the medicine service were 1.76 times more likely to receive preoperative TTE (p < .01). Patients were 2.28 times more likely to receive TTE if they had a history of coronary artery disease (p < .001), and 2.12 times more likely if they had a history of arrhythmia (p < .001). Five patients in the TTE group and one patient in the control group underwent cardiac catheterization prior to surgery, but none of these patients required angioplasty or stent placement. There was no difference in mortality between the TTE group and the control group in hospital (3.8% versus 1.8%, p = .176), at 30 days (6.9% versus 6.6%, p = .90), or at one year (20.6% versus 20.1%, p = .89) respectively. There was no significant difference in major cardiac complications between groups. Average time from admission to operative treatment was 66.5 hours in the TTE group and 34.8 hours in the control group (p < .001). Average time from admission to medical clearance was 43.2 hours in the TTE group and 12.4 hours in the control group (p < .001). There was no difference in the time between medical clearance and operative treatment between the two groups (23.3 hours versus 22.4 hours, p = .639). The TTE group also had a significantly longer length of stay at 8.68 days compared to 6.44 days in the control group (p < .001). Conclusions (d): Preoperative TTE does not help reduce mortality rates in elderly hip fracture patients in either short or long term postoperative periods. In addition TTE delayed surgical treatment, resulted in no cardiac intervention, and increased length of stay. The American Heart Association (AHA) and the American College of Cardiology (ACC) have developed guidelines for perioperative assessment of patients in case of non-cardiac surgery. TTE should not be used as a screening tool in hip fracture patients, but instead used to further evaluate active cardiac conditions.