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Does preoperative hemodynamic preconditioning improve morbidity and mortality after traumatic hip fracture in geriatric patients? A retrospective cohort study

  • Trauma Surgery
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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

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Authors and Affiliations

  1. Klinik für Orthopädie Und Unfallchirurgie, Luzerner Kantonsspital, Spitalstrasse, 6000, Lucerne, Switzerland

    J. Q. Kusen, P. C. R. van der Vet, B. C. Link, R. Babst & F. J. P. Beeres

  2. Klinik für Anästhesie, Luzerner Kantonsspital, Spitalstrasse, 6000, Lucerne, Switzerland

    B. Poblete

  3. Department of Surgery, Diakonessenhuis, Utrecht, The Netherlands

    F. J. G. Wijdicks

  4. Department of Surgery, St. Antoniusziekenhuis, Utrecht, The Netherlands

    D. van der Velde

Authors
  1. J. Q. Kusen
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  2. P. C. R. van der Vet
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  3. F. J. G. Wijdicks
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  4. B. C. Link
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  8. F. J. P. Beeres
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Contributions

J.Q.K., P.C.R.V., F.J.P.B., and B.P. participated in study design. J.Q.K. and P.C.R.V. participated in data collection. J.Q.K. and F.J.P.B participated in statistical analysis. J.Q.K., P.C.R.V., F.J.P.B., and F.J.G.W. participated in article drafting. B.P., D.V., B.C.L., R.B., and F.J.P.B. participated in critical revision of the article.

Corresponding author

Correspondence to F. J. P. Beeres.

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Conflict of interest

J. Q. Kusen, P. C. R. van der Vet, B.C. Link, B. Poblete, D. van der Velde, R. H. Babst, and F. J. P. Beeres declare that they have no conflict of interest.

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Kusen, J.Q., van der Vet, P.C.R., Wijdicks, F.J.G. et al. Does preoperative hemodynamic preconditioning improve morbidity and mortality after traumatic hip fracture in geriatric patients? A retrospective cohort study. Arch Orthop Trauma Surg 141, 1491–1497 (2021). https://doi.org/10.1007/s00402-020-03601-5

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  • DOI: https://doi.org/10.1007/s00402-020-03601-5

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