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Postoperative Complications

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Fractures in the Elderly

Part of the book series: Aging Medicine ((AGME))

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Abstract

Not long ago, old patients were frequently denied surgical intervention exclusively based on their age. However, as perioperative management improved significantly over the past decades, many elderly patients with multiple comorbidities have undergone surgical procedures, requiring specialized perioperative care. Contrary to the conventional thought that major complications or death occur intraoperatively, most adverse events arise postoperatively, particularly within the first 24 h, and morbidity and mortality rates are twice as high compared to the intraoperative period. In this chapter, we will discuss several common postoperative complications that present in the elderly.

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References

  1. McLaughlin M et al. Preoperative status and risk of complications in patients with hip fractures. J Gen Intern Med 2006;21:219–225.

    Article  PubMed  Google Scholar 

  2. Siddiqui AK, Ahmed S, Delbeau H, Conner D, Maffana J. Lack of physician concordance with guidelines on the perioperative use of beta-blockers. Arch Intern Med 2004;164(6):664–667.

    Article  PubMed  Google Scholar 

  3. Eagle KA, Berger PB, Calkins H, et al. ACC/AHA guideline update for perioperative ­cardiovascular evaluation for noncardiac surgery-executive summary. Circulation 2002;105(10):1257–1267.

    PubMed  Google Scholar 

  4. Hernandez AF, Whellan DJ, Stroud S, Sun JL, O’Connor CM, Jollis JG. Outcomes in heart failure patients after major noncardiac surgery. J Am Coll Cardiol 2004;44(7):1446–1453.

    Article  PubMed  Google Scholar 

  5. Dunlop WE, Rosenblood L, Lawrason L, Birdsall L, Rusnak CH. Effects of age and severity of illness on outcome and length of stay in geriatric surgical patients. Am J Surg 1993;165(5):577–580.

    Article  PubMed  CAS  Google Scholar 

  6. Shah MR, Hasselblad V, et al. Impact of the pulmonary artery catheter in critically ill patients: meta-analysis of randomized clinical trials. JAMA 2005;294:1664–1670.

    Article  PubMed  CAS  Google Scholar 

  7. Binanay C, Califf RM, Hasselblad V, et al. ESCAPE investigators and ESCAPE study coordinators. Evaluation study of congestive heart failure and pulmonary artery catheterization effectiveness: the ESCAPE trial. JAMA 2005;294:1625–1633.

    Article  PubMed  Google Scholar 

  8. Shah MR, O’Connor CM, Sopko G, et al. Evaluation study of congestive heart failure and pulmonary artery catheterization effectiveness (ESCAPE): design and rationale. Am Heart J 2001;141:528–535.

    Article  PubMed  CAS  Google Scholar 

  9. Mangano DT. Perioperative cardiac morbidity. Anesthesiology 1990;72:153–184.

    Article  PubMed  CAS  Google Scholar 

  10. Souders J, Rooke A. Perioperative care for geriatric patients. Ann Longterm Care 2005;13:17–29.

    Google Scholar 

  11. Goldman L. Cardiac risks and complications of noncardiac surgery. Ann Intern Med 1983;98:513–514.

    Google Scholar 

  12. Pedersen T, Eliasen K, Henriksen E. A prospective study of risk factors and cardiopulmonary complications associated with anaesthesia and surgery: risk indicators of cardiopulmonary morbidity. Acta Anaesthesiol Scand 1990;34:144–155.

    Article  PubMed  CAS  Google Scholar 

  13. Polanczyk CA, Goldman L, Marcantonio ER, Orav EJ, Lee TH. Supraventricular arrhythmia in patients having noncardiac surgery: clinical correlates and effect on length of stay. Ann Intern Med 1998;129:279–285.

    PubMed  CAS  Google Scholar 

  14. Pedersen T, Eliasen K, Henriksen E. A prospective study of risk factors and cardiopulmonary complications associated with anaesthesia and surgery: risk indicators of cardiopulmonary morbidity. Acta Anaesthesiol Scand 1990;34:144–155.

    Article  PubMed  CAS  Google Scholar 

  15. McLaughlin M et al. Preoperative status and risk of complications in patients with hip fractures. J Gen Intern Med 2006;21:219–225.

    Article  PubMed  Google Scholar 

  16. Khoo CW, Lip GY. Acute management of atrial fibrillation. Chest 2009;135(3):849–859.

    Article  PubMed  CAS  Google Scholar 

  17. Naccarelli GV, Wolbrette DL, Khan M, Bhatta L, Hynes J, Samii S, Luck J. Old and new antiarrhythmic drugs for converting and maintaining sinus rhythm in atrial fibrillation: comparative efficacy and results of trials. Am J Cardiol 2003;91(6A):15D–26D.

    Article  PubMed  CAS  Google Scholar 

  18. Guralnik JM, Eisenstaedt RS, Ferrucci L, Klein HG, Woodman RC. Prevalence of anemia in persons 65 years and older in the United States: evidence for a high rate of unexplained anemia. Blood 2004;104(8):2263–2268.

    Article  PubMed  CAS  Google Scholar 

  19. Haljamae H, Stefansson T, Wickstrom I. Preanesthetic evaluation of the female geriatric patient with hip fracture. Acta Anaesthesiol Scand 1982;26:393–402.

    Article  PubMed  CAS  Google Scholar 

  20. Gruson KI, Aharonoff GB, Egol KA, et al. The relationship between admission hemoglobin level and outcome after hip fracture. J Orthop Trauma 2002;16:39–44.

    Article  PubMed  Google Scholar 

  21. Kulier A, Gombotz H. Perioperative anemia. Anaesthesist 2001;50(2):73–86.

    Article  PubMed  CAS  Google Scholar 

  22. Wu WC et al. Preoperative hematocrit levels and postoperative outcomes in older patients undergoing noncardiac surgery. JAMA 2007;297(22):2481–2488.

    Article  PubMed  CAS  Google Scholar 

  23. National Guideline Clearinghouse. (1) Perioperative blood transfusion for elective surgery. A national clinical guideline. (2) Perioperative blood transfusion for elective surgery. Update to printed guideline. Available at: http:// www.guideline.gov. Last accessed on November 11, 2010.

  24. Munoz M et al. Role of parenteral iron in transfusion requirements after total hip replacement. A pilot study. Transfus Med 2006;16(2):137–142.

    Article  PubMed  CAS  Google Scholar 

  25. Garcia-Erce JA et al. Perioperative stimulation of erythropoiesis with intravenous iron and erythropoietin reduces transfusion requirements in patients with hip fracture. A prospective observational study. Vox Sang 2005;88(4):235–243.

    Article  PubMed  CAS  Google Scholar 

  26. Cuenca J et al. Perioperative intravenous iron, with or without erythropoietin, plus restrictive transfusion protocol reduce the need for allogeneic blood after knee replacement surgery. Transfusion 2006;46(7):1112–1119.

    Article  PubMed  CAS  Google Scholar 

  27. Goodnough LT, Monk TG, Sicard G, et al. Intraoperative salvage in patients undergoing elective abdominal aortic aneurysm repair: an analysis of cost and benefit. J Vasc Surg 1996;24(2):213–218.

    Article  PubMed  CAS  Google Scholar 

  28. Monk TG, Goodnough LT, Brecher ME, et al. A prospective randomized comparison of three blood conservation strategies for radical prostatectomy. Anesthesiology 1999;91(1):24–33.

    Article  PubMed  CAS  Google Scholar 

  29. Bryson GL, Laupacis A, Wells GA. Does acute normovolemic hemodilution reduce perioperative allogeneic transfusion? A meta-analysis. The international study of perioperative transfusion. Anesth Analg 1998;86(1):9–15.

    Article  PubMed  CAS  Google Scholar 

  30. Monk TG, Goodnough LT. Acute normovolemic hemodilution. Clin Orthop Relat Res 1998;357:74–81.

    Article  PubMed  Google Scholar 

  31. Oldenberg M, Muller RT. The frequency, prognosis and significance of nerve injuries in total hip arthroplasty. Int Orthop 1997;21(1):1–3.

    Article  Google Scholar 

  32. Farrell CM, Springer BD et al. Motor nerve palsy following primary total hip arthroplasty. J Bone Joint Surg Am 2005;87(12):2619–2625.

    Article  PubMed  Google Scholar 

  33. Fleming RE, Michelsen CB, Stinchfield FE. Sciatic paralysis. A complication of bleeding following hip surgery. J Bone Joint Surg Am 1979;61:37–39.

    PubMed  Google Scholar 

  34. Centers for Disease Control and Prevention. Fatalities and injuries from fall among older adults – United States, 1993-2003 and 2001-2005. MMWR Morb Mortal Wkly Rep 2006;55:1221–1224.

    Google Scholar 

  35. Kannus P, Sievanen H, Palvanen M et al. Prevention of falls and consequent injuries in elderly people. Lancet 2005;366:1885–1893.

    Article  PubMed  Google Scholar 

  36. Nyberg L, Gustafson Y, Berggren D, Brannstrom B, Bucht G. Falls leading to femoral neck fractures in lucid older people. Incidence of falls in three different types of geriatric care. A Swedish prospective study. J Am Geriatr Soc 1996;44:156–160.

    PubMed  CAS  Google Scholar 

  37. Nyberg L, Gustafson Y, Janson A, Sandman PO, Eriksson S. Incidence of falls in three different types. Scand J Soc Med 1997;25(1):8–13.

    PubMed  CAS  Google Scholar 

  38. Pils K, Neumann F, Meisner W, Schano W, Vavrovsky G, Van der Cammen TJ. Predictors of falls in elderly people during rehabilitation after hip fracture – who is at risk of a second one? Z Gerontol Geriatr 2003;36(1):16–22.

    Article  PubMed  CAS  Google Scholar 

  39. Tinetti ME. Preventing falls in elderly persons. N Engl J Med 2003;348:42–49.

    Article  PubMed  Google Scholar 

  40. Grey-Micelli D, Capezuti E, Zwicker D, Mezey M, Fulmer T, eds. Preventing falls in acute care: evidence-based geriatric nursing protocols for best practice, 3rd ed. New York, NY: Springer Publishing Company, 2008, pp 161–198.

    Google Scholar 

  41. Stevens M, Holman CD, Bennett N. Prevential falls in older people: impact of an intervention to reduce environmental hazards in home. J Am Geriatr Soc 2001;49:1442–1448.

    Article  PubMed  CAS  Google Scholar 

  42. Capezuti E, Maislin G, Strumpf N, Evans LK. Side rail use and bed-related fall outcome among nursing home residents. J Am Geriatr Soc 2002;50:90–96.

    Article  PubMed  Google Scholar 

  43. Leigzig RM, Cumming RG, Tinetti ME. Drugs and falls in older people: a systematic review and meta-analysis: I. Psychotropic drugs. J Am Geriatr Soc 1999;47:30–35.

    Google Scholar 

  44. Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. N Engl J Med 1988;319:1701–1707.

    Article  PubMed  CAS  Google Scholar 

  45. Haines TP, Bennell KL, Osborne RH, Hill KD. Effectiveness of targeted falls prevention programmes in a subacute setting. A randomised controlled trial. BMJ 2004;328:676–679.

    Article  PubMed  Google Scholar 

  46. Healey F, Monro A Cockram A, et al. Using targeted risk factor reduction to prevent falls in older hospital inpatients. A randomised controlled trial. Age Ageing 2004;33:390–395.

    Article  PubMed  Google Scholar 

  47. Reuben DB, Borok GM, Wolde-Tsadik G, et al. A randomized trial of comprehensive geriatric assessment in the care of hospitalized patients. NEJM 1995;332(20):1345–1350.

    Article  PubMed  CAS  Google Scholar 

  48. Berggren M, Stenvall M, Olofsson B, Gustafson Y. Evaluation of a fall-prevention program in older people after femoral neck fracture: a one-year follow-up. Osteoporosis Int 2008;19(6):801–809.

    Article  CAS  Google Scholar 

  49. Tinetti ME. Multifactorial fall-prevention strategies: time to retreat or advance. J Am Geriatr Soc 2008;56:1563–1570.

    Article  PubMed  Google Scholar 

  50. Chang JT, Ganz DA. Quality indicators for fall and mobility problems in vulnerable elders. J Am Geriatr Soc 2007;55(Suppl 2):S327–S334.

    Article  PubMed  Google Scholar 

  51. Naqvi F, Lee S, Fields S. An evidence-based review of the NICHE guideline for preventing falls in older adults in an acute setting. Geriatrics 2009;64:10–26.

    PubMed  Google Scholar 

  52. Gordon M. Restoring functional independence in the older hip fracture patient. Geriatrics 1989;44(12):48–53; see also pp 56, 59.

    PubMed  CAS  Google Scholar 

  53. Luckey AE, Parsa CH. Fluid and electrolytes in the elderly. Arch Surg 2003;138(10):1055–1060.

    Article  PubMed  Google Scholar 

  54. Sunderam SG, Mankikar GD. Hyponatraemia in the elderly. Age Ageing 1983;12:77–80.

    Article  PubMed  CAS  Google Scholar 

  55. Hirshberg B, Ben-Yehuda A. The syndrome of inappropriate antidiuretic hormone secretion in the elderly. Am J Med 1997;103:270–273.

    Article  PubMed  CAS  Google Scholar 

  56. Laczi F. Etiology, diagnostics and therapy of hyponatremias. Orv Hetil 2008;149(29):1347–1354.

    Article  PubMed  Google Scholar 

  57. Miller PD, Krebs RA, Neal BJ, McIntyre DO. Hypodipsia in geriatric patients. Am J Med 1982;73:354–356.

    Article  PubMed  CAS  Google Scholar 

  58. Snyder NA, Feigal DW, Arieff AI. Hypernatremia in elderly patients: a heterogeneous, morbid, and iatrogenic entity. Ann Intern Med 1987;107:309–319.

    PubMed  CAS  Google Scholar 

  59. Chassagne P, Druesne L, Capet C, et al. Clinical presentation of hypernatremia in elderly patients: a case control study. J Am Geriatr Soc 2006;54(8):1225–1230.

    Article  PubMed  Google Scholar 

  60. Portale AA, Lonergan ET, Tanney DM, Halloran BP. Aging alters calcium regulation of serum concentration of parathyroid hormone in healthy men. Am J Physiol 1997;272:E139–E146.

    PubMed  CAS  Google Scholar 

  61. Garcia Lazaro M, Montero Perez-Barquero M, Carpintero Benitez P. The role of malnutrition and other medical factors in the evolution of patients with hip fracture. An Med Intern 2004;21(11):557–563.

    CAS  Google Scholar 

  62. Lichtblau S. Treatment of hip fractures in the elderly – the decision process. Mt Sinai J Med 2002;69(4):250–260.

    PubMed  Google Scholar 

  63. Huddleston JM, Whitford KJ. Medical care of elderly patients with hip fractures. Mayo Clin Proc 2001;76(3):295–298.

    Article  PubMed  CAS  Google Scholar 

  64. Lavernia CJ, Sierra RJ, Baerga L. Nutritional parameters and short term outcome in arthroplasty. J Am Coll Nutr 1999;18(3):274–278.

    PubMed  CAS  Google Scholar 

  65. Koval KJ, Maurer SG, Su ET, et al. The effects of nutritional status on outcome after hip fracture. J Orthop Trauma 1999;13(3):164–169.

    Article  PubMed  CAS  Google Scholar 

  66. Bastow MD, Rawlings J, Allison SP. Benefits of supplementary tube feeding after fractured neck of femur: a randomised controlled trial. BMJ 1983;287:1589–1592.

    Article  PubMed  CAS  Google Scholar 

  67. Hartgrink HH, Wille J, Konig P, Hermans J, Breslau PJ. Pressure sores and tube feeding in patients with a fracture of the hip: a randomized clinical trial. Clin Nutr 1998;17:287–292.

    Article  PubMed  CAS  Google Scholar 

  68. Sullivan DH, Nelson CL, Bopp MM, Puskarich-May CL, Walls RC. Nightly enteral nutrition support of elderly hip fracture patients: a phase I trial. J Am Coll Nutr 1998;17:155–161.

    PubMed  CAS  Google Scholar 

  69. Tidermark J., Ponzer S., Carlsson P., et al. Effects of protein-rich supplementation and ­nandrolone in lean elderly women with femoral neck fractures. Clin Nutr 2004;23(4):587–596.

    Article  PubMed  CAS  Google Scholar 

  70. Avenell A, Handoll HH. Nutritional supplementation for hip fracture aftercare in older people. Cochrane Database Syst Rev 2006;(4):CD001880.

    Google Scholar 

  71. Bastow MD, Rawlings J, Allison SP. Benefits of supplementary tube feeding after fractured neck of femur: a randomised controlled trial. BMJ 1983;287:1589–1592.

    Article  PubMed  CAS  Google Scholar 

  72. Hartgrink HH, Wille J, Konig P, Hermans J, Breslau PJ. Pressure sores and tube feeding in patients with a fracture of the hip: a randomized clinical trial Clin Nutr 1998;17:287–292.

    Article  PubMed  CAS  Google Scholar 

  73. Kaye KS, Anderson DJ, Sloane R, Chen LF, Choi Y, Link K, Sexton DJ, et al. The effect of surgical site infection on older operative patients. J Am Geriatr Soc 2009;57:46–54.

    Article  PubMed  Google Scholar 

  74. Kaye KS, Sloane R, Sexton DJ et al. Risk factors for surgical site infections in older people. J Am Geriatr Soc 2006;54:391–396.

    Article  PubMed  Google Scholar 

  75. Zuckerman JD. Hip fracture. N Engl J Med 1996;334(23):1519–1525.

    Article  PubMed  CAS  Google Scholar 

  76. Gillespie WJ, Walenkamp G. Antibiotic prophylaxis for surgery for proximal femoral and other closed long bone fractures. Cochrane Database Syst Rev 2001;1(1):CD000244.

    PubMed  Google Scholar 

  77. Classen DC, Evans RS, Pestotnik SL, Horn SD, Menlove RL, Burke JP. The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection. N Engl J Med 1992;326:281–286.

    Article  PubMed  CAS  Google Scholar 

  78. March L, Chamberlain A, Cameron I, Cumming R, Kurrle S, Finnegan T, et al. Prevention, treatment, and rehabilitation of fractured neck of femur. Report from the Northern Sydney Area Fractured Neck of Femur Health Outcomes Project. 1996. Available at: http://www.mja.com.au/public/issues/iprs2/march/fnof.pdf, accessed February 15, 2006.

  79. Tambyah PA, Maki DG. The relationship between pyuria and infection in patients with indwelling urinary catheters: a prospective study of 761 patients. Arch Intern Med 2000;160(5):673–677.

    Article  PubMed  CAS  Google Scholar 

  80. Arozullah AM, Khuri SF, Henderson WG, et al. Development and validation of a multifactorial risk index for predicting postoperative pneumonia after major noncardiac surgery. Ann Intern Med 2001;135(10):847–857.

    PubMed  CAS  Google Scholar 

  81. Skelly JM, Guyatt GH, Kalbfleisch R, Singer J, Winter L. Management of urinary retention after surgical repair of hip fracture. Can Med Assoc J 1992;146:1185–1189.

    CAS  Google Scholar 

  82. Sigel A, Schrott KM. Disturbances of micturition after general surgical operations. Langenbecks Arch Chir 1977;345:563–564.

    Article  PubMed  CAS  Google Scholar 

  83. Johansson I, Athlin E, Frykholm L, Bolinder H, Larsson G. Intermittent versus indwelling catheters for older patients with hip fractures. J Clin Nurs 2002;11:651–656.

    Article  PubMed  Google Scholar 

  84. Southwell-Keely JP, Russo RR, March L, Cumming R, Cameron I, Brnabic AJ. Antibiotic prophylaxis in hip fracture surgery: a metaanalysis. Clin Orthop 2004;(419):179–184.

    Google Scholar 

  85. Smith NK, Albazzaz MK. A prospective study of urinary retention and risk of death after proximal femoral fracture. Age Ageing 1996;25:150–154.

    Article  PubMed  CAS  Google Scholar 

  86. Schaeffer AJ. Catheter-associated bacteriuria. Urol Clin North Am 1986;13(4):735–747.

    PubMed  CAS  Google Scholar 

  87. Sedor J, Mulholland SG. Hospital-acquired urinary tract infections associated with the indwelling catheter. Urol Clin North Am 1999;26(4):821–828.

    Article  PubMed  CAS  Google Scholar 

  88. Nicolle LE. Asymptomatic bacteriuria: when to screen and when to treat, Infect Dis Clin North Am 2003(17):367–394.

    Google Scholar 

  89. Stamm WE. Guidelines for prevention of catheter-associated urinary tract infections. Ann Intern Med 1975;82(3):386–390.

    PubMed  CAS  Google Scholar 

  90. Skelly JM, Guyatt GH, Kalbfleisch R, Singer J, Winter L. Management of urinary retention after surgical repair of hip fracture. Can Med Assoc J 1992;146:1185–1189.

    CAS  Google Scholar 

  91. Morrison RS, Chassin MR, Siu AL. The medical consultant’s role in caring for patients with hip fracture. Ann Intern Med 1998;128:1010–1020.

    PubMed  CAS  Google Scholar 

  92. The National Pressure Ulcer Advisory Panel Updated Staging System. Available at http://www.npuap.org/pr2.htm. Last accessed on November 11, 2010.

  93. Allman RM, Goode PS, Burst N, Bartolucci AA, Thomas DR. Pressure ulcers, hospital complications, and disease severity: impact on hospital costs and length of stay. Adv Wound Care 1999;12:22–30.

    PubMed  CAS  Google Scholar 

  94. Baumgarten M, Margolis D, Berlin JA, et al. Risk factors for pressure ulcers among elderly hip fracture patients. Wound Repair Regen 2003;11:96–103.

    Article  PubMed  Google Scholar 

  95. Abrussezze RS. Early assessment and prevention of pressure ulcers. In: Lee BY, ed. Chronic ulcers of the skin. New York, NY: McGraw-Hill, 1985, pp 1–9.

    Google Scholar 

  96. Allman RM. Pressure ulcers among the elderly. N Engl J Med 1989;320(13):850–853.

    Article  PubMed  CAS  Google Scholar 

  97. Fuhrer MJ, Garber SL, Rintala DH, et al. Pressure ulcers in community-resident persons with spinal cord injury: prevalence and risk factors. Arch Phys Med Rehabil 1993;74(11):1172–1177.

    PubMed  CAS  Google Scholar 

  98. Garber SL, Campion LJ, Krouskop TA. Trochanteric pressure in spinal cord injury. Arch Phys Med Rehabil 1982;63(11):549–552.

    PubMed  CAS  Google Scholar 

  99. Reuler JB, Cooney TG. The pressure sore: pathophysiology and principles of management. Ann Intern Med 1981;94(5):661–666.

    PubMed  CAS  Google Scholar 

  100. Barbenel JC, Ferguson-Pell MW, Kennedy R. Mobility of elderly patients in bed. Measurement and association with patient condition. J Am Geriatr Soc 1986;34(9):633–636.

    PubMed  CAS  Google Scholar 

  101. Lowthian PT. Underpadsin the prevention of decubiti. In: Kenedi RM, Cowden JM, Scales JT, eds. Bedsore biomechanics. Baltimore, MD: University Park Press, 1976, p 141.

    Google Scholar 

  102. Berlowitz DR, Wilking SV. Risk factors for pressure sores. A comparison of cross-sectional and cohort-derived data. J Am Geriatr Soc 1989;37(11):1043–1050.

    PubMed  CAS  Google Scholar 

  103. Bliss M, Simini B. When are the seeds of postoperative pressure sores sown? Often during surgery. BMJ 1999;319:863.

    PubMed  CAS  Google Scholar 

  104. Inouye SK, Studenski S, Tinetti ME, Kuchel GA. Geriatric syndromes: clinical, research, and policy implications of a core geriatric concept. J Am Geriatr Soc 2007;55(5):780–791.

    Article  PubMed  Google Scholar 

  105. Haleem S, Heinert G, Paker MJ. Pressure sores and hip fractures. Injury 2008;39(2):219–223.

    Article  PubMed  CAS  Google Scholar 

  106. Nuffield Institute of Health, University of Leeds, NHS Centre for Review and Dissemination. How effective are pressure relieving interventions for the prevention and treatment of pressure sores? Effective Health Care Bull 1995;2:1–15.

    Google Scholar 

  107. Peromet M, Labbe M, Yourassowsky E, et al. Anaerobic bacteria isolated from decubitus ulcers. Infection 1973;1(4):205–207.

    Article  PubMed  CAS  Google Scholar 

  108. Livesley NJ, Chow AW. Infected pressure ulcers in elderly individuals. Clin Infect Dis 2002;35(11):1390–1396.

    Article  PubMed  Google Scholar 

  109. Brown NK, Thompson DJ. Nontreatment of fever in extended-care facilities. N Engl J Med 1979;300(22):1246–1250.

    Article  PubMed  CAS  Google Scholar 

  110. Agency for Health Care Policy and Research (AHCPR). Treatment of pressure ulcers. Rockville (MD). US Department of Health and Human Services, Public Health Service, Clinical Practice Guideline Number 15. AHCPR Publication No. 95–0652. 1994.

    Google Scholar 

  111. Pompei P, Murphy JB, eds. Geriatric review syllabus: a core curriculum in geriatric medicine, 6th ed. New York, NY: American Geriatric Society, 2006.

    Google Scholar 

  112. Mumcuoglu KY. Clinical applications for maggots in wound care. Am J Clin Dermatol 2001(4):219–227.

    Google Scholar 

  113. Bergstrom N, Bennett MA, Carlson CE, et al. Treatment of pressure ulcers. Clinical practice guideline no. 15. Rockville, MD: US Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research, 1994, pp 47–49.

    Google Scholar 

  114. Lyder CH, Preston J, Grady JN, et al. Quality of care for hospitalized Medicare patients at risk for pressure ulcers. Arch Intern Med 2001;161(12):1549–1554.

    Article  PubMed  CAS  Google Scholar 

  115. Souders J, Rooke A. Perioperative care for geriatric patients. Ann Longterm Care 2005;13(6):17–29.

    Google Scholar 

  116. Marcantonio ER, Flacker JM, Wright RJ, et al. Reducing delirium after hip fracture: a randomized trial. J Am Geriatr Soc 2001;49(5):516–522.

    Article  PubMed  CAS  Google Scholar 

  117. Todd CJ, Freeman CJ, Camilleri-Ferrante C, et al. Differences in mortality after fracture of hip: the east Anglian audit. BMJ 1995;310:904–908.

    PubMed  CAS  Google Scholar 

  118. Anderson FA Jr, Wheeler HB, Goldberg RJ, et al. A population-based perspective of the hospital incidence and case-fatality rates of deep vein thrombosis and pulmonary embolism. The Worcester DVT study. Arch Intern Med 1991;151:933–938.

    Article  PubMed  Google Scholar 

  119. Barsoum WK, Helfand R, Krebs V, et al. Managing perioperative risk in the hipfracture patient. Cleve Clin J Med 2006;73(Suppl 1):S46–S50.

    Article  PubMed  Google Scholar 

  120. Geerts WH, Pineo GF, Heit JA, et al. Prevention of venous thromboembolism: the seventh ACCP conference on antithrombotic and thrombolytic therapy. Chest 2004;126(3 Suppl):338S–400S.

    Article  PubMed  CAS  Google Scholar 

  121. Shorr AF, Kwong LM, Sarnes M, et al. Venous thromboembolism after orthopedic surgery: implications of the choice for prophylaxis. Thromb Res 2007;121(1):17–24.

    Article  PubMed  CAS  Google Scholar 

  122. Moser K., Pulmonary thromboembolism. In: Wilson J, Harrison TR, et al, eds. Harrison’s principles of internal medicine, 12th ed, vol 1. New York, NY: McGraw-Hill, 1991, pp 1090.

    Google Scholar 

  123. Kniffin WD, Baron J, Barrett J, et al. The epidemiology of diagnosed pulmonary embolism and deep venous thrombosis in the elderly. Arch Intern Med 154:861–866.

    Google Scholar 

  124. Geerts WH, Heit JA, Clagett GP, et al. Prevention of venous thromboembolism. Chest 2001;119:132S–1325S.

    Article  PubMed  CAS  Google Scholar 

  125. Morpurgo M, Schmid C, Mandelli V. Factors influencing the clinical diagnosis of pulmonary embolism: analysis of 229 postmortem cases. Int J Cardiol 1998;65(Suppl I):S79–S82.

    Article  PubMed  Google Scholar 

  126. Stein PD, Beemath A, Matta F, et al. Clinical characteristics of patients with acute pulmonary embolism: data from PIOPED II. Am J Med 2007;120:871–879.

    Article  PubMed  Google Scholar 

  127. Wells PS, Ginsberg JS, Anderson DR et al. Use of a clinical model for safe management of patients with suspected pulmonary embolism. Ann Intern Med 1998;129:997–1005.

    PubMed  CAS  Google Scholar 

  128. The PIOPED Investigators. Value of the ventilation/perfusion scan in acute pulmonary embolism: results of the prospective investigation of pulmonary embolism diagnosis (PIOPED). JAMA 1990;263(20):2753–2759.

    Google Scholar 

  129. Stein PD, Hull RD, Pineo GF. The role of newer diagnostic techniques in the diagnosis of pulmonary embolism. Curr Opin Pulm Med 1999;5:212–215.

    Article  PubMed  CAS  Google Scholar 

  130. Lindeque B, Schoeman H, Dommisse G, Boeyens MC, Vlok AL. Fat embolism and the fat embolism syndrome. J Bone Joint Surg 1987;69B:128–131.

    Google Scholar 

  131. Rodger M, Markropoulos D et al. Diagnostic value of the electrocardiogram in suspected pulmonary embolism. Am J Cardiol 2000;86(7):807–809.

    Article  PubMed  CAS  Google Scholar 

  132. Moores LK, Jackson WL, Shorr AF, Jackson JL. Meta-analysis: outcomes in patients with suspected pulmonary embolism managed with computed tomographic pulmonary angiography. Ann Intern Med 2007;141:866–874.

    Google Scholar 

  133. Egermayer P, Town GI, Turner JG, et al. Usefulness of D-dimer, blood gas, and respiratory rate measurements for excluding pulmonary embolism. Thorax 1998;53:830–834.

    Article  PubMed  CAS  Google Scholar 

  134. Tapson VF, Carroll BA, Davidson BL, et al. American Thoracic Society. Clinical practice guideline: the diagnostic approach to acute venous thromboembolism. Am J Respir Crit Care Med 1999;160:1043–1066.

    PubMed  CAS  Google Scholar 

  135. The Task Force on Pulmonary Embolism, European Society of Cardiology. Guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J 2000;21:1301–1336.

    Google Scholar 

  136. Ginsberg JS, Wells PS, Kearon C, et al. Sensitivity and specificity of a rapid whole-blood assay for D-dimer in the diagnosis of pulmonary embolism. Ann Intern Med 1998;129(12):1006–1011.

    PubMed  CAS  Google Scholar 

  137. Schulman S, Granqvist S, Holmstrom M, et al. The duration of oral anticoagulant therapy after a second episode of venous thromboembolism. The duration of anticoagulation trial study group. N Engl J Med 1997;336(6):393–398.

    Article  PubMed  CAS  Google Scholar 

  138. Ramzi DW, Leeper KV. DVT and pulmonary embolism: part II. Treatment and prevention. Am Fam Physician 2004;69(12):2841.

    PubMed  Google Scholar 

  139. Levine M, Hirsh J, Weitz J, et al. A randomized trial of a single bolus dosage regimen of recombinant tissue plasminogen activator in patients with acute pulmonary embolism. Chest 1990;98(6):1473–1479.

    Article  PubMed  CAS  Google Scholar 

  140. Hirsh J, Dalen JE, Anderson DR, et al. Oral anticoagulants: mechanism of action, clinical effectiveness, and optimal therapeutic range. Chest 1998;114(5 Suppl):445S–469S.

    Article  PubMed  CAS  Google Scholar 

  141. Mageral F, Tscherne H. Zur Diagnose, Therapie und proplylaxe der fettembolie. Langenbecks Arch Klin Chir 1966;314:29.

    Google Scholar 

  142. Ganong RB. Fat emboli syndrome in isolated fractures of the tibia and femur. Clin Ortho 1993;291:208–214.

    Google Scholar 

  143. Collins JA, Hudson TL, Hamacher WR et al. Systemic fat embolism in four combat causalities. Ann Surg 1968;167:493–499.

    Article  PubMed  CAS  Google Scholar 

  144. Johnson MJ, Lucas GL. Fat embolism syndrome. Orthopedics 1996;19:41.

    PubMed  CAS  Google Scholar 

  145. Fulde GW, Harrison P. Fat embolism – a review. Arch Emerg Med 1991;8:233–239.

    PubMed  CAS  Google Scholar 

  146. Kaplan RP, Grant JN, Kaufman AJ. Dermatologic features of the fat embolism syndrome. Cutis 1986;38:52–55.

    PubMed  CAS  Google Scholar 

  147. Lindeque B, Schoeman H, Dommisse G, Boeyens MC, Vlok AL. Fat embolism and the fat embolism syndrome. J Bone Joint Surg 1987;69B:128–131.

    Google Scholar 

  148. Gurd AR. Fat embolism: an aid to diagnosis. J Bone Joint Surg Br 1970;52b:732–737.

    Google Scholar 

  149. Van den Brande FGJ, Hellemans S, De Schepper A, et al. Post-traumatic severe fat embolism syndrome with uncommon CT findings. Anaesth Intensive Care 2006;34:102–106.

    PubMed  CAS  Google Scholar 

  150. Riska EB, Van Bonsdorrf H, Hakkien S, Japonia O, Kilivoyo O, Papillainen T. Prevention of fat embolism by early fixation of fractures in patients with multiple injuries. Injury 1976;8:110–116.

    Article  PubMed  CAS  Google Scholar 

  151. Schonfeld SA, Ploysongsang Y, DiLisio R, et al. Fat embolism prophylaxis with corticosteroids. Ann Intern Med 1983;99:438–443.

    PubMed  CAS  Google Scholar 

  152. Mellor A, Soni N. Fat embolism. Anaesthesia 2001;56:145–154.

    Article  PubMed  CAS  Google Scholar 

  153. Bulger EM, Smith DG, Maier RV, Jurkovich GJ. Fat embolism syndrome. A 10-year review. Arch Surg 1997;132(4):435–439.

    PubMed  CAS  Google Scholar 

  154. Bitsch M, Foss N, Kristensen B, et al. Pathogenesis of and management strategies for postoperative delirium after hip fracture: a review. Acta Orthop Scand 2004;75(4):378–389.

    Article  PubMed  Google Scholar 

  155. Morrison RS, Chassin MR, Siu AL. The medical consultant’s role in caring for patients with hip fracture. Ann Intern Med 1998;128(12 Pt 1):1010–1102.

    PubMed  CAS  Google Scholar 

  156. Bellelli G, Frisoni GB, Pagani M, et al. Does cognitive performance affect physical therapy regimen after hip fracture surgery? Aging Clin Exp Res 2007;19(2):119–124.

    PubMed  Google Scholar 

  157. Feil D, Marmon T, Unutzer J. Cognitive impairment, chronic medical illness, and risk of mortality in an elderly cohort. Am J Geriatr Psychiatry 003;11(5):551–560.

    Google Scholar 

  158. Kiely DK, Bergmann MA, Murphy KM, et al. Delirium among newly admitted post-acute facility patients: prevalence, symptoms, and severity. J Gerontol A Biol Sci Med Sci 2003;58(5): M441–M445.

    PubMed  Google Scholar 

  159. Bitsch M, Foss N, Kristensen B, et al. Pathogenesis of and management strategies for postoperative delirium after hip fracture: a review. Acta Orthop Scand 2004;75(4):378–389.

    Article  PubMed  Google Scholar 

  160. Marcantonio ER, Flacker JM, Wright RJ, et al. Reducing delirium after hip fracture: a randomized trial. J Am Geriatr Soc 2001;49(5):516–522.

    Article  PubMed  CAS  Google Scholar 

  161. Ely EW, Inouye SK, Bernard GR, et al. Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit. JAMA 2001;286(21):2703–2710.

    Article  PubMed  CAS  Google Scholar 

  162. Inouye SK, Van Dyck CH, Alessi CA, et al. Clarifying confusion: the Confusion Assessment Method: a new method for detection of delirium. Ann Intern Med 1990;113(12):941–948.

    PubMed  CAS  Google Scholar 

  163. Trzepacz P, Breitbart W, Franklin J, et al. Practice guideline for the treatment of patients with delirium. American Psychiatric Association; Available at: http://www.psychiatryonline.com/pracGuide/pracGuideTopic_2.aspx

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Kim, JH. (2011). Postoperative Complications. In: Pignolo, R., Keenan, M., Hebela, N. (eds) Fractures in the Elderly. Aging Medicine. Humana Press. https://doi.org/10.1007/978-1-60327-467-8_8

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