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A nationwide observational cohort study of the relationship between beta-blockade and survival after hip fracture surgery
Örebro universitet, Institutionen för medicinska vetenskaper. Division of Trauma and Emergency Surgery, Department of Surgery, Karolinska University Hospital, Stockholm, Sweden; Division of Surgery, Department of Clinical Science Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.
Örebro universitet, Institutionen för medicinska vetenskaper. Department of Orthopedic Surgery, Örebro University Hospital, Örebro, Sweden.ORCID-id: 0000-0003-3436-1026
Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Orthopedic Surgery, Örebro University Hospital, Örebro, Sweden.
Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Division of Trauma and Emergency Surgery, Department of Surgery, Örebro University Hospital, Örebro, Sweden.
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2022 (Engelska)Ingår i: European Journal of Trauma and Emergency Surgery, ISSN 1863-9933, E-ISSN 1863-9941, Vol. 48, nr 2, s. 743-751Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

PURPOSE: Despite advances in the care of hip fractures, this area of surgery is associated with high postoperative mortality. Downregulating circulating catecholamines, released as a response to traumatic injury and surgical trauma, is believed to reduce the risk of death in noncardiac surgical patients. This effect has not been studied in hip fractures. This study aims to assess whether survival benefits are gained by reducing the effects of the hyper-adrenergic state with beta-blocker therapy in patients undergoing emergency hip fracture surgery.

METHODS: This is a retrospective nationwide observational cohort study. All adults [Formula: see text] 18 years were identified from the prospectively collected national quality register for hip fractures in Sweden during a 10-year period. Pathological fractures were excluded. The cohort was subdivided into beta-blocker users and non-users. Poisson regression with robust standard errors and adjustments for confounders was used to evaluate 30-day mortality.

RESULTS: 134,915 patients were included of whom 38.9% had ongoing beta-blocker therapy at the time of surgery. Beta-blocker users were significantly older and less fit for surgery. Crude 30-day all-cause mortality was significantly increased in non-users (10.0% versus 3.7%, p < 0.001). Beta-blocker therapy resulted in a 72% relative risk reduction in 30-day all-cause mortality (incidence rate ratio 0.28, 95% CI 0.26-0.29, p < 0.001) and was independently associated with a reduction in deaths of cardiovascular, respiratory, and cerebrovascular origin and deaths due to sepsis or multiorgan failure.

CONCLUSIONS: Beta-blockers are associated with significant survival benefits when undergoing emergency hip fracture surgery. Outlined results strongly encourage an interventional design to validate the observed relationship.

Ort, förlag, år, upplaga, sidor
Urban und Vogel Medien und Medizin Verlagsgesellsc , 2022. Vol. 48, nr 2, s. 743-751
Nyckelord [en]
Beta-blockers, Hip fractures, Mortality
Nationell ämneskategori
Ortopedi
Identifikatorer
URN: urn:nbn:se:oru:diva-89079DOI: 10.1007/s00068-020-01588-7ISI: 000612583000001PubMedID: 33507317Scopus ID: 2-s2.0-85099985820OAI: oai:DiVA.org:oru-89079DiVA, id: diva2:1523784
Anmärkning

Funding Agency:

Örebro University  

Tillgänglig från: 2021-01-29 Skapad: 2021-01-29 Senast uppdaterad: 2024-03-06Bibliografiskt granskad
Ingår i avhandling
1. The Association Between Beta-Blocker Therapy and Mortality in Hip Fracture Patients
Öppna denna publikation i ny flik eller fönster >>The Association Between Beta-Blocker Therapy and Mortality in Hip Fracture Patients
2022 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

Hip fractures have been a major concern within the healthcare systems for many years. National efforts have been done to improve the overall outcomes during the last decades. Despite this, the mortality rates one year after hip fracture surgery are as high as 27% and have remained high the past 15 years. Patients that suffer from hip fractures are often elderly and have several comorbidities. The orthopaedic trauma and subsequent emergency surgery impose an activation of the sympathetic nervous system mediated through the release of catecholamines. This causes a hyper-adrenergic state, which can be harmful if prolonged, or if the patient already has a strain caused by comorbidities forgoing the injury, especially on the cardiovascular system. This gave rise to the thought of blocking the adrenergic receptor activation in hip fracture patients as an effort to reduce the mortality rates.

Papers I and II investigates the association between beta-blocker therapy and short-term mortality in hip fracture patients. In Paper I, (n=2443) patients operated in Orebro County between 2013 to 2017 were extracted from The National Quality Register for Hip Fractures (Rikshöft), to enable a more detailed review of the medical journals. The patients were divided into a betablocker cohort and a beta-blocker naive cohort. Results showed an 18% reduction in the risk of postoperative mortality within 90 days of surgery. In Paper II, all adults operated for traumatic hip fractures in Sweden between 2008 to 2017 were extracted from The National Quality Register for Hip Fractures and then cross-referenced with data from registers of The National Board of Health and Welfare. This resulted in a total of 134,915 patients eligible for analysis. The results demonstrated a 72% risk reduction in postoperative mortality within 30 days of surgery in the cohort with ongoing beta-blocker therapy.

Paper III explored if the effect seen in Paper I-II remains up to one year using the same database as Paper II. The results demonstrated that the association between beta-blocker therapy and reduction in the risk of mortality,extending up to one year postoperatively, with the main effect seen during the first postoperative period.

Paper IV investigates the interaction between the Revised Cardiac Risk Index and beta-blocker therapy related to 30-day post-operative mortality. This study concluded that all geriatric hip fracture patients could benefit from beta-blockers, but a more pronounced effect was seen in those with cardiac risk factors.

Ort, förlag, år, upplaga, sidor
Örebro: Örebro University, 2022. s. 69
Serie
Örebro Studies in Medicine, ISSN 1652-4063 ; 252
Nyckelord
Trauma, Hip Fracture, Beta-Blocker, Hyperadrenergic State, Stress, Mortality
Nationell ämneskategori
Kirurgi
Identifikatorer
urn:nbn:se:oru:diva-95781 (URN)9789175294179 (ISBN)
Disputation
2022-02-25, Örebro universitet, Campus USÖ, hörsal C1, Södra Grev Rosengatan 32, Örebro, 09:00 (Engelska)
Opponent
Handledare
Tillgänglig från: 2021-12-07 Skapad: 2021-12-07 Senast uppdaterad: 2024-03-06Bibliografiskt granskad

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Ahl, RebeckaMohammad Ismail, AhmadBorg, TomasSjölin, GabrielForssten, Maximilian PeterCao, YangWretenberg, PerMohseni, Shahin
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Institutionen för medicinska vetenskaperRegion Örebro län
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