Background and Objectives: Fractures of the proximal femur are a life-changing and life-threatening event for older people. Concomitant malnutrition has been described as an independent risk factor for complications and mortality. Therefore, we examined the influence of albumin and body mass index (BMI) as parameters for the nutritional state on the outcome after geriatric hip fracture surgery. Materials and Methods: Data were retrospectively collected from hospital information systems, and complications and all other parameters were obtained from patient charts. We included patients aged 70 years or above with a fracture of the proximal femur. We excluded periprosthetic and peri-implant fractures and patients with a missing BMI or albumin value. Results: Patients with a BMI below 20 kg/m² were more likely to be female but did not differ from the normal BMI group in terms of baseline parameters. Patients with hypoalbuminemia had a higher ASA grade and Charlson Comorbidity Index, as well as a lower hemoglobin value and prothrombin time compared to those with normal albumin values and low BMI. Hypoalbuminemia was associated with significantly increased rates of complications (57.9% vs. 46.7%, p = 0.04) and mortality (10.3% vs. 4.1%, p = 0.02). Blood loss and transfusion rates were higher in the hypoalbuminemia group. Patients with a BMI below 20 kg/m² had a higher risk of intraoperative cardiac arrest (2.6% vs. 0.4%, p = 0.05) but did not show higher mortality rates than patients with a BMI above 20 kg/m². However, the outcome parameter could not be confirmed in the regression analysis. Conclusions: Hypoalbuminemia might be an indicator for more vulnerable patients with a compromised hemoglobin value, prothrombin time, and ASA grade. Therefore, it is also associated with higher mortality and postoperative complications. However, hypoalbuminemia was not an independent predictor for mortality or postoperative complications, but low albumin values were associated with a higher CCI and ASA grade than in patients with a BMI below 20 kg/m².

Background and Objectives: The increased use of direct oral anticoagulants (DOACs) results in an increased prevalence of DOAC treatment in hip fractures patients. However, the impact of DOAC treatment on perioperative management of hip fracture patients is limited. In this study, we describe the prevalence of DOAC treatment in a population of hip fracture patients and compare these patients with patients taking vitamin K antagonists (VKA) and patients not taking anticoagulants. Materials and Methods: This study is a retrospective analysis from the Registry for Geriatric Trauma (ATR-DGU). The data were collected prospectively from patients with proximal femur fractures treated between January 2016 and December 2018. Among other factors, anticoagulation was surveyed. The primary outcome parameter was time-to-surgery. Further parameters were: type of anesthesia, surgical complications, soft tissue complications, length of stay and mortality. Results: In total, 11% (n = 1595) of patients took DOACs at the time of fracture, whereas 9.2% (n = 1325) were on VKA therapy. During the study period, there was a shift from VKA to DOACs. The time-to-surgery of patients on DOACs and of patients on VKA was longer compared to patients who did not take any anticoagulation. No significant differences with regard to complications, type of anesthesia and mortality were found between patients on DOACs compared to VKA treatment. Conclusion: An increased time-to-surgery in patients taking DOACs and taking VKA compared to non-anticoagulated patients was found. This underlines the need for standardized multi-disciplinary orthopedic, hematologic and ortho-geriatric algorithms for the management of hip fracture patients under DOAC treatment. In addition, no significant differences regarding complications and mortality were found between DOAC and VKA users. This demonstrates that even in the absence of widely available antidotes, the safe management of geriatric patients under DOACs with proximal femur fractures is possible.

Summary: Patients suffering from complications during inpatient treatment after hip fracture surgery are associated with a worse mid-term outcome. While surgically treatable complications only delay the healing process, internal complications seem to worsen the outcome in the long run. All complications come with significant increased costs during the hospital stay. Purpose: Due to the demographic changes, the importance of hip fractures is still increasing nowadays. Not only surgical but also medical complications represent a major challenge in the treatment of those patients. Nevertheless, only few is known about the functional, medical, and economic consequences of complications. Methods: A total of 402 hip fracture patients ≥ 60 years were observed prospectively at a German university hospital. Complications were assessed during the inpatient stay and classified by Clavien and Dindo. Afterwards their influence on acute care costs was examined as well as their influence on the mortality, health-related quality of life (HRQL) (EQ5D), functional capacities (Barthel index), and mobility (Tinetti score) in the follow-up periods of 6 and 12 months. Results: Complications that required surgical revision/treatment (type III) were associated with an increased 6 months’ mortality, while type II and IV complications did not influence mortality after 6 and 12 months. Six months after surgery, HRQL, Barthel score, and Tinetti score were reduced in patients suffering from all different types of complications. After 12 months however, HRQL, Barthel score, and Tinetti score following type II and IV complications remained reduced, while the scores improved in patients suffering from type III complication. All types of complications led to significantly increased acute care costs. Conclusions: The results of the present study emphasize the crucial role of perioperative complications in older patients with hip fractures. Therefore, special attention has to be given to the prevention of those complications, e.g., with orthogeriatric treatment models, which have been shown to be effective in the reduction of complications.

Background and Objectives: Cemented hemi arthroplasty is a common and effective procedure performed to treat femoral neck fractures in elderly patients. The bone cement implantation syndrome (BCIS) is a severe and potentially fatal complication which can be associated with the implantation of a hip prosthesis. The aim of this study was to investigate the influence of a modified cementing technique on the incidence of BCIS. Material and Methods: The clinical data of patients which were treated with a cemented hip arthroplasty after the introduction of the modified 3rd generation cementing technique were compared with a matched group of patients who were treated with a 2nd generation cementing technique. The anesthesia charts for all patients were reviewed for the relevant parameters before, during and after cementation. Each patient was classified as having no BCIS (grade 0) or BCIS grade 1,2, or 3 depending on the severity of hypotension, hypoxia loss of consciousness. Results: A total of 92 patients with complete data sets could be included in the study. The mean age was 83 years. 43 patients (Group A) were treated with a 2nd and 49 patients (Group B) with a 3rd generation cementing technique. The incidence of BCIS grade 1,2, and 3 was significantly higher (p = 0,036) in group A (n = 25; 58%) compared to group B (n = 17; 35%). Early mortality was higher in group A (n = 4) compared to group B (n = 0). Conclusions: BCIS is a potentially severe complication with a significant impact on early mortality following cemented hemiarthroplasty of the hip for the treatment of proximal femur fracture. Using a modified 3rd generation cementing technique, it is possible to significantly reduce the incidence of BCIS and its associated mortality.

Purpose: The German Society for Geriatrics recommends the “ISAR” questionnaire as a screening tool for patients ≥ 70 for geriatric screening in emergency rooms. Although the ISAR-score is collected routinely in the “AltersTraumaRegister DGU^®” (ATR-DGU), to date less is known about the predictive value of the “ISAR”-score in geriatric trauma patients. Patients and Methods: Currently, 84 clinics participate in the ATR-DGU. This evaluation is limited to the subgroup of proximal femur fractures from 2016– 2018. Patients ≥ 70 years, who underwent surgery for a hip fracture are included in the ATR-DGU. In this evaluation, the influence of the “ISAR”-score on mortality, length of stay, mobility and the destination of discharge was examined. Results: Overall 10,098 patients were included in the present study. The median age was 85 years (interquartile range (IQ) 80– 89 years). According to the ISAR-score 80.6% (n=8142) of the patients were classified as geriatric patients (cut off “ISAR”-score ≥ 2 points). These group of patients had a length of stay of 16 days (IQ10.1– 22.1) compared to the non-geriatric patient cohort showing a length of stay of 15 days (IQ10.1– 20.1). Patients showing an ISAR-score ≥ 2 had an increased risk of being discharged to a nursing home (OR 8.25), not being able to walk (OR 12.52) and higher risk of mortality (OR 3.45). Conclusion: The “ISAR”-score shows predictive power for the length of stay, mobility, hospital mortality and discharge after hospital in the collective of geriatric trauma patients. It therefore seems suitable as a screening tool for geriatric trauma patients in the emergency department and should be considered in this context.