Clinical Study Of Preoperative And Postoperative 1-year Stroke In The Elderly Patients With Fractures

Part One Incidence and risk factors associated with postoperative stroke in the elderly patients undergoing hip fracture surgeryObjectives: Stroke is an acute cerebrovascular disease,because of its acute onset and serious condition,it has been widely concerned by clinicians.The incidence of stroke in elderly patients with hip fractures is very low,but once it happens,the health of patients will be severely hit.By far,there is still scarce data on postoperative stroke in elderly patients with hip fractures.This study aims to explore the risk factors associated with postoperative stroke in the elderly with a hip fracture and guide clinicians in stroke prevention for the elderly with hip fractures.Methods: This was a retrospective study of prospectively collected data.Between October 2014 to December 2018,patients aged above 65 years who underwent operative treatment for hip fractures were included.Inpatient medical surveillance and scheduled telephone follow-up at 1,3,6,and 12 months after the operation was conducted to identify who developed an incident stroke.Demographic variables of interest were extracted from inpatient medical records,such as age,gender,residence,smoking,alcohol consumption,hypertension,etc.Fracture-related variables included fracture type,injury mechanism,preoperative waiting time,etc.Surgery-related variables such as operation time,anesthesia method,American Society of Anesthesiologists grading score,etc.Laboratory indicators such as red blood cell distribution width,total cholesterol,triglyceride,red blood cell,white blood cell,platelet,etc.Univariate analysis and multivariate logistic regression analysis were used to identify the independent risk factors associated with stroke.Results: During the study period,a total of 3743 patients were included,among whom 56 were found to have a stroke after the operation,representing an incidence of 1.5%(95% CI,1.1 to 1.9%).The multivariate analyses showed that advanced age(1-year increment;OR,1.32;95% CI,1.08 to 1.48),history of previous stroke(OR,4.79;95% CI,1.86 to 6.56),American society of anesthesiologists III and above(OR,2.62;95% CI,1.27 to 3.68),long-term use of aspirin(OR,3.63;95% CI,1.41 to 4.78),and elevated RDW level(each increment of 1%,OR,1.21;95% CI,1.02 to 1.36)were independently associated with postoperative stroke.Conclusions: In this study,advanced age,history of stroke,American Society of Anesthesiologists grading score of III or above,long-term use of aspirin,and increased red blood cell distribution width were identified as risk factors for postoperative stroke in elderly patients with hip fracture.Although most are not modifiable,examples include advanced age,prior stroke,and long-term aspirin use.However,basing on these risk factors,clinicians can stratify the patient’s risk by assessing the risk level of postoperative stroke in elderly patients with hip fracture,and then target the treatment of elderly patients with hip fracture stroke with different risk levels.Part Two Epidemiological characteristics of preoperative acute stroke following surgically treated fracture in geriatric patientsObjective: There are few studies on the incidence of acute stroke during hospitalization in elderly patients with fractures.Therefore,this study investigated the epidemiological characteristics and related risk factors of preoperative acute stroke following surgically treated fracture in geriatric patients.Methods: A retrospective study on 19749 patients admitted to the Third Hospital of Hebei Medical University for surgical treatment of fractures between December 2014 and December 2019 was conducted.The medical records were collected including sex,age,body mass index(BMI),smoking,alcohol consumption,age-adjusted Charlson Comorbidity Index(ACCI),fracture site and type of surgery;time from injury to admission,time of stroke symptoms,preoperative stay,length of hospital stay,blood pressure at admission,and preoperative anticoagulant medication;brain DWI showed cerebral infarction and neck color ultrasound showed carotid artery;glucose(GLU),hemoglobin A1C(Hb A1C),red blood cell(RBC),hemoglobin(HGB),total serum cholesterol(TC),serum C-reactive protein(CRP),serum homocysteine(HCY),serum albumin(ALB),plasma fibrinogen(FBG),brain natriuretic peptide(BNP);complications during hospitalization.The epidemiological status and risk factors of acute stroke before surgery in elderly patients with fractures during hospitalization were analyzed.Results: In this study,86 patients with preoperative acute stroke in elderly patients with fractures were included,with an incidence of 0.43%.According to the analysis,there were 32 male patients(37.2%)and 54 female patients(62.8%),with an average age of(75.3±1.1)years.There were 12smokers(14.0%),including 10 male smokers(11.6%)and 2 female smokers(2.3%).There were 2 patients(2.3%)who drank alcohol,and all of them were male.In addition,there were 3 distal femur fractures(3.5%),4 humeral fractures(4.7%),4 femoral shaft fractures(4.7%),3 olecranon fractures(3.5%),and 1 upper tibia fracture(1.2%).Internal fixation was the main type of surgery in 47 cases(54.7%).The occurrence time of stroke was concentrated within one week after admission,with an average of 3 days after admission.Symptoms were mainly involving sudden limb weakness and speech problems,predominantly in the basal ganglia and occipital lobe infarction parts,with 12 cases(14.0%)presenting with cerebral hemorrhage and 74 cases(86.0%)with acute ischemic stroke.Based on the pathogenesis of atherosclerotic thrombotic cerebral infarction,most were watershed infarction,in addition,there were 2 cases(2.3%)with cerebral embolism.The most obvious abnormal indicators in the first laboratory examination on admission were RBC 3.3×1012/L,HGB(115.0±3.6)g/L,CRP 33.6mg/g,HCY 23.3umol/L,and ALB(36.8±0.8)g/L.The most common complications during hospitalization were deep venous thrombosis of lower extremities 48(55.8%)anemia 45(52.3%)electrolyte disturbance 38(44.1%)hypoproteinemia 35(40.1%)and pulmonary infection 33(38.4%).Conclusions: Preoperative acute stroke is fatal in elderly patients with fracture,and females are more common than male patients,suggesting that the prevention of preoperative acute stroke in elderly women after fracture should be more emphasized.In addition,most patients showed significant abnormalities in blood pressure before stroke and abnormal RBC,HGB,CRP,HCY,ALB and other indicators on admission.Acute cerebral atherosclerosis thrombotic cerebral infarction,or stroke of watershed infarction is higher;and for people at high risk of stroke,careful check must be conducted to exclude intracranial vascular occlusion lesions;meanwhile,patient’s blood pressure and laboratory test results for the first time should be paid specific attention.In addition,health education and psychological counseling should be strengthened to avoid provoking an incident stroke because of mood swings,unstable blood pressure,inadequate intake and much bleeding.During the perioperative period,attention should be paid to fluid supplement to ensure cerebral perfusion,and the symptoms of stroke should be timely and early detected to reduce adverse consequences.