Jeanne M. Huddleston

Medical Care of Elderly Patients With Hip Fractures

Medical morbidity associated with hip fractures in the elderly population is considerable. The all-cause mortality rate is 24% at 12 months. The functional limitations of survivors can be pronounced. As the American population ages, hip fractures will substantially affect the utilization of hospital resources. Several issues, including preoperative clearance and related surgical timing, deep venous thrombosis prophylaxis, delirium, nutrition, and urinary tract management, are important in the care of these patients. A close partnership between orthopedic surgeons and clinicians provides the best strategy of care for the subset of patients with multisystemic complications.

Unplanned transfers to the intensive care unit: The role of the shock index†

BACKGROUND Unplanned (unexpected) transfers to the intensive care unit (ICU) are typically preceded by physiologic instability. However, trends toward instability may be subtle and not accurately reflected by changes in vital signs. The shock index (SI) (heart rate/systolic blood pressure as an indicator of left ventricular function, reference value of 0.54) may be a simple alternative means to predict clinical deterioration. OBJECTIVE To assess the association of the SI with unplanned ICU transfers. DESIGN Retrospective case-control study. SETTING Academic medical center. PATIENTS Fifty consecutive general medical patients with unplanned ICU transfers between 2003 and 2004 and 50 matched controls admitted to the same general medical unit between 2002 and 2004. MEASUREMENTS Demographic data and vital signs abstracted from chart review. RESULTS The SI was associated with unplanned ICU transfer at values of 0.85 or greater (P < 0.02; odds ratio, 3.0) and there was a significant difference between the median of worst shock indices of cases and controls (0.87 vs. 0.72; P < 0.005). There was no significant difference in age, race, admission ward, or Charlson Comorbidity Index, but hospital stay for cases was significantly longer (mean [standard deviation, SD], 14.8 [9.7] days vs. 5.7 [6.3] days; P < 0.001). CONCLUSIONS SI is associated with unplanned transfers to the ICU from general medical units at values of 0.85 or greater. Future studies will determine whether SI is more accurate than simple vital signs as an indicator of clinical decline. If so, it may be a useful trigger to activate medical emergency or rapid response teams (RRTs).

Impact of body mass on hospital resource use in total hip arthroplasty.

OBJECTIVE To determine the impact of BMI on post-operative outcomes and resource utilization following elective total hip arthroplasty (THA). DESIGN A retrospective cohort analysis on all primary elective THA patients between 1996 and 2004. Primary outcomes investigated using regression analyses included length of stay (LOS) and costs (US dollars). SETTING Mayo Clinic Rochester, a tertiary care centre. SUBJECTS Patients were stratified by pre-operative BMI as normal (18.5-24.9 kg/m(2)), overweight (25.0-29.9 kg/m(2)), obese (30.0-34.9 kg/m(2)) and morbidly obese (> or =35.0 kg/m(2)). Of 5642 patients, 1362 (24.1 %) patients had a normal BMI, 2146 (38.0 %) were overweight, 1342 (23.8 %) were obese and 792 (14.0 %) were morbidly obese. RESULTS Adjusted LOS was similar among normal (4.99 d), overweight (5.00 d), obese (5.02 d) and morbidly obese (5.17 d) patients (P = 0.20). Adjusted overall episode costs were no different (P = 0.23) between the groups of normal (

Body Mass Index and the Impact on Hospital Resource Use in Patients Undergoing Total Knee Arthroplasty

17,211), overweight (

Myocardial Infarction After Hip Fracture Repair:: A Population-Based Study

17,462), obese (

Teaching High-value, Cost-conscious Care: Improving Residents' Knowledge and Attitudes

17,195) and morbidly obese (

Widely used track and trigger scores: Are they ready for automation in practice?

17,655) patients. Overall operative and anaesthesia costs were higher in the morbidly obese group (

Predictors of ischemic stroke after hip operation: A population‐based study

5688) than in normal (

Why the C-statistic is not informative to evaluate early warning scores and what metrics to use

5553), overweight (

Body mass index (BMI) and risk of noncardiac postoperative medical complications in elderly hip fracture patients: A population‐based study

5549) and obese (