| 1. |
- Al Ani, Amer, et al.
(author)
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Impacts of severity of Covid-19 infection on the morbidity and mortality of surgical patients
- 2022
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In: Annals of Medicine and Surgery. - : Elsevier. - 2049-0801. ; 79
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Journal article (peer-reviewed)abstract
- Introduction: One of the challenges of surgery on patients with active SARS-CoV-2(severe acute respiratory syndrome coronavirus 2) infection is the increased risk of postoperative morbidity and mortality. Aim: This study will describe and compare the postoperative morbidity and mortality in asymptomatic patients or those with mild infection with those with severe COVID-19 infection undergoing elective or and emergency surgery. Materials and methods: This is a retrospective study of 37 COVID19 patients who had the infection 7 days prior to and 30 days after emergency or elective surgery. Patients were divided to two groups. Group1: the asymptomatic or those with mild infection that is diagnosed just before surgery (14 patients). Group 2: those who were admitted to the hospital because of severe COVID-19 and were operated for COVID-19 related complications (23 patients). Morbidity and mortality of both groups was studied. Results: There was no significant difference in gender between the two groups. There were 5 females (2 in group 1, and 3 in group 2) and 32 males (12 in group 1, and 20 in group 2). Mean age for all patients was 49.8years (38 for group 1 and 57 for group2). Median age for all patients was 50 years (37.5 for group 1 and 57 years for group 2). Sepsis developed in 7 patients (1 patient in group 1 and in 6 patients in group 2). Statistically there was no significant difference in occurrence of sepsis between the two groups. There was a significant difference in the intensive care stay between the two groups (higher in group 2). Four deaths were reported in group 1 and fourteen in group 2. Eighteen out of thirty-seven patients died. Conclusion: Severity of COVID-19 infection will prolong the hospitalization and ICU stay in surgical patients with no significant effect on mortality.
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| 2. |
- Al-Ani, Amer
(author)
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Hip fracture in young and old subjects : aspects on risk factors and outcome
- 2011
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Doctoral thesis (other academic/artistic)abstract
- Hip fractures, the most serious osteoporosis-related fractures, mainly affect older people. The functional outcome for many hip fracture patients remains to be improved. Hip fractures in young patients are uncommon, but lifelong disability may prevail. The aim of this thesis was to examine possibly modifiable factors correlated with functional outcome in older subjects with hip fracture. Furthermore, to study background data and trauma mechanism in young and middle-aged patients with femoral neck fracture. Finally, the frequency of osteoporosis and sarcopenia in younger patients with a hip fracture was examined. Study I A total of 850 patients with hip fractures were included. Outcomes including return to independent living, pressure ulcer (PU), length of hospital stay (LOS), and mortality were considered in relation to time between admission and surgery. Patients operated upon later than 36 and 48 hours after admission were less likely to return to independent living while there was no significant difference when using the 24-hour cut-off limit. The incidence of PU and LOS in the groups operated on later was increased at all 3 cut-off limits. The mortality rate did not differ. Study II A total of 246 patients with femoral neck fracture and cognitive impairment were included. All were able to walk before the fracture. Significant predictors of preserved walking ability and ADL function at 4- and 12-month follow-up were: discharge to rehabilitation unit, walking ability, and ADL function prior to fracture, whereas surgical method was not. Patients discharged to rehabilitation unit were less likely to be wheelchair bound at any follow-up occasion. Study III Included were 27 young (20-49 years of age) and 158 middle-aged (50-69 years of age) patients with a femoral neck fracture. They were studied regarding trauma mechanisms and risk factors for osteoporosis and hip fracture. A minority of both the young and middle age group had a high-energy trauma as a cause for the hip fracture. Life style factors and other non-trauma related risk factors appeared to be main contributors to the occurrence of the hip fracture in both age groups. Study IV The study population was the same as in Study III. Bone mineral density (BMD) and fat-free mass (FFM) were determined by Dual X-ray Absorptiometry (DXA). FFM index (FFMI) was calculated as the ratio of FFM (kg) and height squared. One third of the study population had FFMI below the 10th percentile of a of an age- and gender-matched reference population, i.e. indicating sarcopenia. All young patients had a femoral neck BMD below the mean for age and 90% of the middle-aged patients had osteopenia (56%) or osteoporosis (34%). In conclusion, the result of this thesis indicates that early operation of patients with hip fracture improves the ability to return to independent living, reduces the incidence of pressure ulcers and reduces the length of hospital stay. Discharge to rehabilitation unit, a factor we can influence, and previous function were both associated with preserved walking ability and ADL function in cognitively impaired patients with hip fracture. A minority, both in the young and middle-aged patients had a high-energy trauma as a cause for the hip fracture. And most of these patients have one or more risk factors for hip fracture and low BMD regardless of the trauma mechanism. One third has signs of sarcopenia i.e. low muscle mass.
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| 3. |
- Al-Ani, Amer, et al.
(author)
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Low bone mineral density and fat free mass in young and middle-aged patients with a femoral neck fracture
- 2015
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In: European Journal of Clinical Investigation. - : Wiley. - 0014-2972 .- 1365-2362. ; 45:8, s. 800-806
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Journal article (peer-reviewed)abstract
- BackgroundReduced bone mineral density (BMD) together with muscle wasting and dysfunction, that is sarcopenia, emerges as a risk factor for hip fracture. The aim of this study was to examine body composition and BMD and their relationship with trauma mechanisms in young and middle-aged patients with femoral neck fracture.Materials and methodsAltogether, 185 patients with femoral neck fracture aged 20–69 were included. BMD, body composition and fat-free mass index (FFMI) were determined by dual-X-ray absorptiometry (DXA), and trauma mechanisms were registered.ResultsNinety per cent of the whole study population had a femoral neck BMD below the mean for age. In the young patients (< 50 years), 27% had a Z-score of BMD ≤ −2 SD. More than half of the middle-aged patients (50–69 years) had osteopenia, that is T-score −1 to −2·5, and 35% had osteoporosis, that is T-score < −2·5, at the femoral neck. Patients with low-energy trauma, sport injury or high-energy trauma had a median standardised BMD of 0·702, 0·740 vs. 0·803 g/cm2 (P = 0·03), and a median FFMI of 15·9, 17·7 vs. 17·5 kg/m2 (P < 0·001), respectively. FFMI < 10th percentile of an age- and gender-matched reference population was observed in one-third.ConclusionsA majority had low BMD at the femoral neck, and one-third had reduced FFMI (i.e. sarcopenia). Patients with fracture following low-energy trauma had significantly lower femoral neck BMD and FFMI than patients with other trauma mechanisms. DXA examination of both BMD and body composition could be of value especially in those with low-energy trauma.
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| 4. |
- Al-Ani, Amer N., et al.
(author)
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Does Rehabilitation Matter in Patients With Femoral Neck Fracture and Cognitive Impairment? : A Prospective Study of 246 Patients
- 2010
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In: Archives of Physical Medicine and Rehabilitation. - : Elsevier BV. - 0003-9993 .- 1532-821X. ; 91:1, s. 51-57
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Journal article (peer-reviewed)abstract
- Objective: To identify factors associated with preserved walking ability and Katz activities of daily living (ADLs) index at 4-month and 12-month follow-up in cognitively impaired patients with femoral neck fracture. Design: Population-based cohort study. Setting: A multicenter study of the Stockholm Hip Fracture Group including 4 university hospitals. Participants: Consecutive patients (N=246) with femoral neck fracture, older than 65 years (mean, 84y; 72% women) with cognitive impairment (known dementia or low [0-2 points] score) in Short Portable Mental Status Questionnaire [0-10 points]) and able to walk before the fracture. Interventions: Not applicable. Main Outcome Measure: Walking ability and ADLs index at 4-month and 12-month follow-up. Results: Significant predictors of preserved walking ability at 12-month follow-up were discharge to rehabilitation unit (odds ratio [OR]=2.83: confidence interval [CI], 1.1-7.26; P=.03) and walking ability before the fracture (OR=8.98; Cl, 3.52-22.93; P<.001), while type of surgery was not (P=.197). Analyses were adjusted for age, sex, American Society of Anesthesiologists score, fracture type, and surgical method. Corresponding predictors of preserved Katz ADLs index at 12-month follow-up, after adjustment for age and sex, were discharge to rehabilitation unit (OR=5.33; Cl, 1.44-19.65: P=.012) and ADLs index before fracture (OR=2.5; Cl. 1.8-3.5: P<.001), while type of surgery was not (P=.376). Conclusions: Discharge to rehabilitation unit, a factor we can influence, was associated with preserved walking ability and ADLs index in cognitively impaired patients with hip fracture.
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| 5. |
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| 6. |
- Al-Ani, Amer N., et al.
(author)
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Low bone mineral density and fat-free mass in younger patients with a femoral neck fracture
- 2015
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In: European Journal of Clinical Investigation. - : Wiley. - 0014-2972 .- 1365-2362. ; 45:8, s. 800-806
-
Journal article (peer-reviewed)abstract
- Background Reduced bone mineral density (BMD) together with muscle wasting and dysfunction, that is sarcopenia, emerges as a risk factor for hip fracture. The aim of this study was to examine body composition and BMD and their relationship with trauma mechanisms in young and middle-aged patients with femoral neck fracture. Materials and methods Altogether, 185 patients with femoral neck fracture aged 20-69 were included. BMD, body composition and fat-free mass index (FFMI) were determined by dual-X-ray absorptiometry (DXA), and trauma mechanisms were registered. Results Ninety per cent of the whole study population had a femoral neck BMD below the mean for age. In the young patients (<50years), 27% had a Z-score of BMD-2 SD. More than half of the middle-aged patients (50-69years) had osteopenia, that is T-score -1 to -25, and 35% had osteoporosis, that is T-score<-25, at the femoral neck. Patients with low-energy trauma, sport injury or high-energy trauma had a median standardised BMD of 0702, 0740 vs. 0803g/cm(2) (P=003), and a median FFMI of 159, 177 vs. 175kg/m(2) (P<0001), respectively. FFMI<10th percentile of an age- and gender-matched reference population was observed in one-third. Conclusions A majority had low BMD at the femoral neck, and one-third had reduced FFMI (i.e. sarcopenia). Patients with fracture following low-energy trauma had significantly lower femoral neck BMD and FFMI than patients with other trauma mechanisms. DXA examination of both BMD and body composition could be of value especially in those with low-energy trauma.
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| 7. |
- Campenfeldt, Pierre, et al.
(author)
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Function, sarcopenia and osteoporosis 10 years after a femoral neck fracture in patients younger than 70 years
- 2022
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In: Injury. - : Elsevier. - 0020-1383 .- 1879-0267. ; 53:4, s. 1496-1503
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Journal article (peer-reviewed)abstract
- Background and purpose: A femoral neck fracture (FNF) may have long-term effects on the patient's func-tion, also in patients younger than 70 years. These long-term effects are not well described, since most studies have short follow-ups. The aim of this study was to investigate clinical outcome by performance -based functional tests, hand grip strength, and hip function in different subgroups. The secondary aim was to study surgical complications, bone mineral density (BMD) and occurrence of sarcopenia 10 years after a FNF. Patients and methods: A prospective multicenter study with a 10-year follow-up of patients aged 20- 69 years with a FNF treated with internal fixation (IF). Five-times sit-to-stand test (5TSST), 4-m walking speed test, hand grip strength (HGS) and Harris Hip Score (HHS) were performed.A radiographic examination of the hip was performed and re-operations were registered. Bone min-eral density (BMD) at the hip, spine and total body composition were assessed with dual energy x-ray absorptiometry (DXA). Present sarcopenia was determined by the combination of reduced functional per-formance and low fat-free mass index (FFMI).Results: A total of 58 patients were included. 5TSTS was normal in 45% of the patients and old age was associated with poorer performance ( p < 0.001). 76% of the study population had a normal speed gait and likewise, old age ( p = 0.005) and walking aids ( p = 0.001) were associated with poor performance. HGS was normal in 82% of the men and 64% of the women. HHS showed that 85% had a good/excellent function. A major re-operation was performed in 34% of the patients with displaced FNF and in 20% of patients with non-displaced FNF. 74% displayed osteopenia and 12% osteoporosis. 17% of the men and 38% of the women had sarcopenia.Interpretation: The majority of patients less than 70 years of age with a FNF treated with IF, had normal functional tests, muscle strength and a good hip function ten years post-operatively. However, one in ten had osteoporosis, and one third was sarcopenic which indicate the importance of encouraging regular muscle preserving resistance training after hip fracture.(c) 2022 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license ( http://creativecommons.org/licenses/by/4.0/ )
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| 8. |
- Flodin, Lena, et al.
(author)
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Additive effects of nutritional supplementation, together with bisphosphonates, on bone mineral density after hip fracture : a 12-month randomized controlled study
- 2014
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In: Clinical Interventions in Aging. - 1176-9092 .- 1178-1998. ; 9, s. 1043-1050
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Journal article (peer-reviewed)abstract
- Background: After a hip fracture, a catabolic state develops, with increased bone loss during the first year. The aim of this study was to evaluate the effects of postoperative treatment with calcium, vitamin D, and bisphosphonates (alone or together) with nutritional supplementation on total hip and total body bone mineral density (BMD). Methods: Seventy-nine patients (56 women), with a mean age of 79 years (range, 61-96 years) and with a recent hip fracture, who were ambulatory before fracture and without severe cognitive impairment, were included. Patients were randomized to treatment with bisphosphonates (risedronate 35 mg weekly) for 12 months (B; n=28), treatment with bisphosphonates along with nutritional supplementation (40 g protein, 600 kcal daily) for the first 6 months (BN; n=26), or to controls (C; n=25). All participants received calcium (1,000 mg) and vitamin D3 (800 IU) daily. Total hip and total body BMD were assessed with dual-energy X-ray absorptiometry at baseline, 6, and 12 months. Marker of bone resorption C-terminal telopeptide of collagen I and 25-hydroxy vitamin D were analyzed in serum. Results: Analysis of complete cases (70/79 at 6 months and 67/79 at 12 months) showed an increase in total hip BMD of 0.7% in the BN group, whereas the B and C groups lost 1.1% and 2.4% of BMD, respectively, between baseline and 6 months (P=0.071, between groups). There was no change in total body BMD between baseline and 12 months in the BN group, whereas the B group and C group both lost BMD, with C losing more than B (P=0.009). Intention-to-treat analysis was in concordance with the complete cases analyses. Conclusion: Protein-and energy-rich supplementation in addition to calcium, vitamin D, and bisphosphonate therapy had additive effects on total body BMD and total hip BMD among elderly hip fracture patients.
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| 9. |
- Flodin, Lena, et al.
(author)
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Effects of protein-rich nutritional supplementation and bisphosphonates on body composition, handgrip strength and health-related quality of life after hip fracture : a 12-month randomized controlled study
- 2015
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In: BMC Geriatrics. - : Springer Science and Business Media LLC. - 1471-2318. ; 15
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Journal article (peer-reviewed)abstract
- Background: The catabolic state that follows hip fracture contributes to loss of muscle mass and strength, that is sarcopenia, which impacts functional ability and health-related quality of life. Measures to prevent such long-term postoperative consequences are of important concern. The aim of this study was to evaluate the combined effects of protein-rich nutritional supplementation and bisphosphonate on body composition, handgrip strength and health-related quality of life following hip fracture. Methods: The study included 79 men and women with hip fracture, mean age 79 years (SD 9), without severe cognitive impairment, who were ambulatory and living independently before fracture. Patients were randomized postoperatively to receive liquid supplementation that provided 40 g of protein and 600 kcal daily for six months after the fracture, in addition to bisphosphonates once weekly for 12 months (group N, n = 26), or bisphosphonates alone once weekly for 12 months (group B, n = 28). All patients, including the controls (group C, n = 25) received calcium 1 g and vitamin D3 800 IU daily. Body composition as measured by dual-energy X-ray absorptiometry (DXA), handgrip strength (HGS) and health-related quality of life (HRQoL) were registered at baseline, six and 12 months postoperatively. Results: There were no differences among the groups regarding change in fat-free mass index (FFMI), HGS, or HRQoL during the study year. Intra-group analyses showed improvement of HGS between baseline and six months in the N group (P = 0.04). HRQoL decreased during the first year in the C and B groups (P = 0.03 and P = 0.01, respectively) but not in the nutritional supplementation N group (P = 0.22). Conclusions: Protein-rich nutritional supplementation was unable to preserve FFMI more effectively than vitamin D and calcium alone, or combined with bisphosphonate, in this relatively healthy group of hip fracture patients. However, trends toward positive effects on both HGS and HRQoL were observed following nutritional supplementation.
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| 10. |
- Hellström, Per M., et al.
(author)
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Normal gastric emptying time of a carbohydrate-rich drink in elderly patients with acute hip fracture : a pilot study
- 2017
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In: BMC Anesthesiology. - : Springer Science and Business Media LLC. - 1471-2253 .- 1471-2253. ; 17
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Journal article (peer-reviewed)abstract
- Background: Guidelines for fasting in elderly patients with acute hip fracture are the same as for other trauma patients, and longer than for elective patients. The reason is assumed stress-induced delayed gastric emptying with possible risk of pulmonary aspiration. Prolonged fasting in elderly patients may have serious negative metabolic consequences. The aim of our study was to investigate whether the preoperative gastric emptying was delayed in elderly women scheduled for surgery due to acute hip fracture. Methods: In a prospective study gastric emptying of 400 ml 12.6% carbohydrate rich drink was investigated in nine elderly women, age 77-97, with acute hip fracture. The emptying time was assessed by the paracetamol absorption technique, and lag phase and gastric half-emptying time was compared with two gender-matched reference groups: ten elective hip replacement patients, age 45-71 and ten healthy volunteers, age 28-55. Results: The mean gastric half-emptying time in the elderly study group was 53 +/- 5 (39-82) minutes with an expected gastric emptying profile. The reference groups had a mean half-emptying time of 58 +/- 4 (41-106) and 59 +/- 5 (33-72) minutes, indicating normal gastric emptying time in elderly with hip fracture. Conclusion: This pilot study in women with an acute hip fracture shows no evidence of delayed gastric emptying after an orally taken carbohydrate-rich beverage during the pre-operative fasting period. This implies no increased risk of pulmonary aspiration in these patients. Therefore, we advocate oral pre-operative management with carbohydrate-rich beverage in order to mitigate fasting-induced additive stress in the elderly with hip fracture.
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