To Örebro University

oru.seÖrebro University Publications
Change search
Link to record
Permanent link

Direct link
Mohammad Ismail, AhmadORCID iD iconorcid.org/0000-0003-3436-1026
Publications (10 of 35) Show all publications
Borg, T., Forssten, M. P., Mohammad Ismail, A., Cao, Y. & Mohseni, S. (2025). Trochanteric hip fractures treated surgically-outcome in a ten-year cohort of 46,121 patients from the Swedish National Hip Fracture Registry. OTA international : the open access journal of orthopaedic trauma, 8(1), Article ID e358.
Open this publication in new window or tab >>Trochanteric hip fractures treated surgically-outcome in a ten-year cohort of 46,121 patients from the Swedish National Hip Fracture Registry
Show others...
2025 (English)In: OTA international : the open access journal of orthopaedic trauma, E-ISSN 2574-2167, Vol. 8, no 1, article id e358Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To compare postoperative mortality regarding 2 techniques in the treatment of trochanteric hip fractures (THFs). DESIGN: Retrospective cohort study. SETTING: National databases.

PATIENTS: All consecutive surgically treated THF cases between 2008 and 2017 were included. Pathological fractures or patients younger than 60 years were excluded.

INTERVENTION: Patients were grouped based on the surgical technique: sliding hip screw (SHS) or intramedullary (IM) nail. This data set was cross-referenced with a National Board of Health and Welfare's patient registry and a Cause of Death registry.

MAIN OUTCOME MEASUREMENTS: Mortality, comorbidities, and length of stay (LOS).

RESULTS: Forty-six thousand one hundred twenty-one cases were included. Twenty-five thousand eight hundred seventy-seven patients received a SHS, and 20,244 received an IM nail. Patients in the IM group were more often female (71.8% vs. 69.2%, P < 0.001), slightly less fit for surgery (American Society of Anesthesiologists score ≥3: 61.2% vs. 60.1%, P = 0.003), and more frail (Orthopedic Frailty Score ≥2: 54.2% vs. 52.8%, P = 0.005). Multifragment fractures were more prevalent in the IM nail group (66.6% vs. 32.0%, P < 0.001), which suffered from a higher comorbidity burden. After adjusting for potential confounders, no clinically significant differences in 7-day, 30-day, 90-day, or 1-year postoperative mortality were observed. Subgroup analyses focusing on 2-fragment and multifragment fractures could not detect any difference in mortality. LOS was 1 day shorter for the IM nail group as a whole.

CONCLUSIONS: Based on 10 years of data including 46,121 patients with THF managed with SHS or IM nail, no difference was observed in mortality up to 1 year postoperatively, when comparing surgical technique. LOS was shorter for the IM nail group.

Place, publisher, year, edition, pages
Wolters Kluwer Health, 2025
National Category
Orthopaedics Surgery
Identifiers
urn:nbn:se:oru:diva-118999 (URN)10.1097/OI9.0000000000000358 (DOI)39881839 (PubMedID)
Available from: 2025-01-31 Created: 2025-01-31 Last updated: 2025-01-31Bibliographically approved
Mohammad Ismail, A., Forssten, M. P., Hildebrand, F., Sarani, B., Ioannidis, I., Cao, Y., . . . Mohseni, S. (2024). Cardiac risk stratification and adverse outcomes in surgically managed patients with isolated traumatic spine injuries. European Journal of Trauma and Emergency Surgery, 50(2), 523-530
Open this publication in new window or tab >>Cardiac risk stratification and adverse outcomes in surgically managed patients with isolated traumatic spine injuries
Show others...
2024 (English)In: European Journal of Trauma and Emergency Surgery, ISSN 1863-9933, E-ISSN 1863-9941, Vol. 50, no 2, p. 523-530Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: As the incidence of traumatic spine injuries has been steadily increasing, especially in the elderly, the ability to categorize patients based on their underlying risk for the adverse outcomes could be of great value in clinical decision making. This study aimed to investigate the association between the Revised Cardiac Risk Index (RCRI) and adverse outcomes in patients who have undergone surgery for traumatic spine injuries.

METHODS: All adult patients (18 years or older) in the 2013-2019 TQIP database with isolated spine injuries resulting from blunt force trauma, who underwent spinal surgery, were eligible for inclusion in the study. The association between the RCRI and in-hospital mortality, cardiopulmonary complications, and failure-to-rescue (FTR) was determined using Poisson regression models with robust standard errors to adjust for potential confounding.

RESULTS: A total of 39,391 patients were included for further analysis. In the regression model, an RCRI ≥ 3 was associated with a threefold risk of in-hospital mortality [adjusted IRR (95% CI): 3.19 (2.30-4.43), p < 0.001] and cardiopulmonary complications [adjusted IRR (95% CI): 3.27 (2.46-4.34), p < 0.001], as well as a fourfold risk of FTR [adjusted IRR (95% CI): 4.27 (2.59-7.02), p < 0.001], compared to RCRI 0. The risk of all adverse outcomes increased stepwise along with each RCRI score.

CONCLUSION: The RCRI may be a useful tool for identifying patients with traumatic spine injuries who are at an increased risk of in-hospital mortality, cardiopulmonary complications, and failure-to-rescue after surgery.

Place, publisher, year, edition, pages
Urban und Vogel Medien und Medizin Verlagsgesellsc, 2024
Keywords
Cardiopulmonary complications, Mortality, Revised Cardiac Risk Index, Risk stratification, Traumatic spine injury
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:oru:diva-110622 (URN)10.1007/s00068-023-02413-7 (DOI)001135545400001 ()38170276 (PubMedID)2-s2.0-85181522328 (Scopus ID)
Funder
Örebro University
Available from: 2024-01-09 Created: 2024-01-09 Last updated: 2024-05-02Bibliographically approved
Forssten, M. P., Cao, Y., Mohammad Ismail, A., Tennakoon, L., Spain, D. A. & Mohseni, S. (2024). Comparative Analysis of Frailty Scores for Predicting Adverse Outcomes in Hip Fracture Patients: Insights from the United States National Inpatient Sample. Journal of Personalized Medicine, 14(6), Article ID 621.
Open this publication in new window or tab >>Comparative Analysis of Frailty Scores for Predicting Adverse Outcomes in Hip Fracture Patients: Insights from the United States National Inpatient Sample
Show others...
2024 (English)In: Journal of Personalized Medicine, E-ISSN 2075-4426, Vol. 14, no 6, article id 621Article in journal (Refereed) Published
Abstract [en]

The aim of the current investigation was to compare the ability of several frailty scores to predict adverse outcomes in hip fracture patients. All adult patients (18 years or older) who suffered a hip fracture due to a fall and underwent surgical fixation were extracted from the 2019 National Inpatient Sample (NIS) Database. A combination of logistic regression and bootstrapping was used to compare the predictive ability of the Orthopedic Frailty Score (OFS), the Nottingham Hip Fracture Score (NHFS), the 11-factor modified Frailty Index (11-mFI) and 5-factor (5-mFI) modified Frailty Index, as well as the Johns Hopkins Frailty Indicator. A total of 227,850 patients were extracted from the NIS. In the prediction of in-hospital mortality and failure-to-rescue (FTR), the OFS surpassed all other frailty measures, approaching an acceptable predictive ability for mortality [AUC (95% CI): 0.69 (0.67-0.72)] and achieving an acceptable predictive ability for FTR [AUC (95% CI): 0.70 (0.67-0.72)]. The NHFS demonstrated the highest predictive ability for predicting any complication [AUC (95% CI): 0.62 (0.62-0.63)]. The 11-mFI exhibited the highest predictive ability for cardiovascular complications [AUC (95% CI): 0.66 (0.64-0.67)] and the NHFS achieved the highest predictive ability for delirium [AUC (95% CI): 0.69 (0.68-0.70)]. No score succeeded in effectively predicting venous thromboembolism or infections. In summary, the investigated frailty scores were most effective in predicting in-hospital mortality and failure-to-rescue; however, they struggled to predict complications.

Place, publisher, year, edition, pages
MDPI, 2024
Keywords
Johns Hopkins Frailty Indicator, Modified Frailty Index, Nottingham Hip Fracture Score, Orthopedic Frailty Score, frailty, hip fracture, logistic regression, morbidity, mortality, prediction
National Category
Orthopaedics
Identifiers
urn:nbn:se:oru:diva-114472 (URN)10.3390/jpm14060621 (DOI)001256642300001 ()38929842 (PubMedID)2-s2.0-85196882937 (Scopus ID)
Available from: 2024-06-28 Created: 2024-06-28 Last updated: 2024-07-25Bibliographically approved
Mohseni, S., Forssten, M. P., Mohammad Ismail, A., Cao, Y., Hildebrand, F., Sarani, B. & Ribeiro, M. A. (2024). Investigating the link between frailty and outcomes in geriatric patients with isolated rib fractures. Trauma surgery & acute care open, 9(1), Article ID e001206.
Open this publication in new window or tab >>Investigating the link between frailty and outcomes in geriatric patients with isolated rib fractures
Show others...
2024 (English)In: Trauma surgery & acute care open, E-ISSN 2397-5776, Vol. 9, no 1, article id e001206Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Studies have shown an increased risk of morbidity in elderly patients suffering rib fractures from blunt trauma. The association between frailty and rib fractures on adverse outcomes is still ill-defined. In the current investigation, we sought to delineate the association between frailty, measured using the Orthopedic Frailty Score (OFS), and outcomes in geriatric patients with isolated rib fractures.

METHODS: All geriatric (aged 65 years or older) patients registered in the 2013-2019 Trauma Quality Improvement database with a conservatively managed isolated rib fracture were considered for inclusion. An isolated rib fracture was defined as the presence of ≥1 rib fracture, a thorax Abbreviated Injury Scale (AIS) between 1 and 5, an AIS ≤1 in all other regions, as well as the absence of pneumothorax, hemothorax, or pulmonary contusion. Based on patients' OFS, patients were classified as non-frail (OFS 0), pre-frail (OFS 1), or frail (OFS ≥2). The prevalence ratio (PR) of composite complications, in-hospital mortality, failure-to-rescue (FTR), and intensive care unit (ICU) admission between the OFS groups was determined using Poisson regression models to adjust for potential confounding.

RESULTS: A total of 65 375 patients met the study's inclusion criteria of whom 60% were non-frail, 29% were pre-frail, and 11% were frail. There was a stepwise increased risk of complications, in-hospital mortality, and FTR from non-frail to pre-frail and frail. Compared with non-frail patients, frail patients exhibited a 87% increased risk of in-hospital mortality [adjusted PR (95% CI): 1.87 (1.52-2.31), p<0.001], a 44% increased risk of complications [adjusted PR (95% CI): 1.44 (1.23-1.67), p<0.001], a doubling in the risk of FTR [adjusted PR (95% CI): 2.08 (1.45-2.98), p<0.001], and a 17% increased risk of ICU admission [adjusted PR (95% CI): 1.17 (1.11-1.23), p<0.001].

CONCLUSION: There is a strong association between frailty, measured using the OFS, and adverse outcomes in geriatric patients managed conservatively for rib fractures.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2024
Keywords
Frailty, geriatrics, rib fractures
National Category
Geriatrics
Identifiers
urn:nbn:se:oru:diva-111653 (URN)10.1136/tsaco-2023-001206 (DOI)001162591700007 ()38347893 (PubMedID)2-s2.0-85184814992 (Scopus ID)
Available from: 2024-02-21 Created: 2024-02-21 Last updated: 2024-03-11Bibliographically approved
Mohammad Ismail, A., Hildebrand, F., Forssten, M. P., Ribeiro, M. A. F., Chang, P., Cao, Y., . . . Mohseni, S. (2024). Orthopedic Frailty Score and adverse outcomes in patients with surgically managed isolated traumatic spinal injury. Trauma surgery & acute care open, 9(1), Article ID e001265.
Open this publication in new window or tab >>Orthopedic Frailty Score and adverse outcomes in patients with surgically managed isolated traumatic spinal injury
Show others...
2024 (English)In: Trauma surgery & acute care open, E-ISSN 2397-5776, Vol. 9, no 1, article id e001265Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: With an aging global population, the prevalence of frailty in patients with traumatic spinal injury (TSI) is steadily increasing. The aim of the current study is to evaluate the utility of the Orthopedic Frailty Score (OFS) in assessing the risk of adverse outcomes in patients with isolated TSI requiring surgery, with the hypothesis that frailer patients suffer from a disproportionately increased risk of these outcomes.

METHODS: The Trauma Quality Improvement Program database was queried for all adult patients (18 years or older) who suffered an isolated TSI due to blunt force trauma, between 2013 and 2019, and underwent spine surgery. Patients were categorized as non-frail (OFS 0), pre-frail (OFS 1), or frail (OFS ≥2). The association between the OFS and in-hospital mortality, complications, and failure to rescue (FTR) was determined using Poisson regression models, adjusted for potential confounding.

RESULTS: A total of 43 768 patients were included in the current investigation. After adjusting for confounding, frailty was associated with a more than doubling in the risk of in-hospital mortality (adjusted incidence rate ratio (IRR) (95% CI): 2.53 (2.04 to 3.12), p<0.001), a 25% higher overall risk of complications (adjusted IRR (95% CI): 1.25 (1.02 to 1.54), p=0.032), a doubling in the risk of FTR (adjusted IRR (95% CI): 2.00 (1.39 to 2.90), p<0.001), and a 10% increase in the risk of intensive care unit admission (adjusted IRR (95% CI): 1.10 (1.04 to 1.15), p=0.004), compared with non-frail patients.

CONCLUSION: The findings indicate that the OFS could be an effective method for identifying frail patients with TSIs who are at a disproportionate risk of adverse events.

LEVEL OF EVIDENCE: Level III.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2024
Keywords
Complications, frailty, mortality, spine
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-115436 (URN)10.1136/tsaco-2023-001265 (DOI)001313010400001 ()39005709 (PubMedID)2-s2.0-85198731723 (Scopus ID)
Available from: 2024-08-16 Created: 2024-08-16 Last updated: 2024-10-01Bibliographically approved
Mohammad Ismail, A., Forssten, M. P., Cao, Y., Ioannidis, I., Forssten, S. P., Sarani, B. & Mohseni, S. (2024). Predicting morbidity and mortality after surgery for isolated traumatic spinal injury without spinal cord injury. Journal of Trauma and Acute Care Surgery, Article ID 10.1097/TA.0000000000004480.
Open this publication in new window or tab >>Predicting morbidity and mortality after surgery for isolated traumatic spinal injury without spinal cord injury
Show others...
2024 (English)In: Journal of Trauma and Acute Care Surgery, ISSN 2163-0755, E-ISSN 2163-0763, article id 10.1097/TA.0000000000004480Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Traumatic spinal injuries are associated with a high risk of morbidity and mortality. The aim of this study is to investigate which variables best predict adverse outcomes in patients who had surgery for isolated traumatic spinal injury without spinal cord injury.

METHODS: The American College of Surgeons Trauma Quality Improvement Program database was used to identify adult (18 years or older) surgically managed patients with an isolated traumatic spinal injury, without spinal cord injury admitted between 2013 and 2021. An isolated injury was defined as a spine Abbreviated Injury Scale score ≥2 and an Abbreviated Injury Scale score ≤1 in the remaining body regions, as well as corresponding International Classification of Diseases, Ninth and Tenth Revision, codes. The predictive value of demographic, clinical, and comorbidity data was evaluated using logistic regression models and ranked using the permutation importance method.

RESULTS: A total of 39,457 patients were included in the study, of whom 554 died during hospitalization. The most important variables for predicting in-hospital mortality were age, sex, Glasgow Coma Scale on admission, Orthopedic Frailty Score, and cervical spine injury. The most important variables for predicting complications were age, cervical spine injury, the need for cervical spine surgery, Revised Cardiac Risk Index, and alcohol use disorder. Finally, age, cervical spine injury, sex, Glasgow Coma Scale on admission, and Orthopedic Frailty Score had the highest relative importance when predicting failure to rescue. Models based on the five most important variables for each outcome demonstrated an excellent predictive ability for in-hospital mortality (area under the receiver operating characteristic curve [AUROC], 0.84; 95% confidence interval [CI], 0.82–0.86) and failure to rescue (AUROC [95% CI], 0.86 [0.84–0.87]) as well as an acceptable predictive ability for complications (AUROC [95% CI], 0.72 [0.71–0.73]).

CONCLUSION: The most important factors identified to predict mortality, complications, and failure to rescue in traumatic spinal injury patients without spinal cord injury who undergo surgery were patients' age, sex, frailty, cervical spine injury that necessitated surgical intervention, and cardiovascular risk.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2024
Keywords
feature importance, morbidity, mortality, prediction, Traumatic spinal injury
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-118361 (URN)10.1097/TA.0000000000004480 (DOI)2-s2.0-85210287830 (Scopus ID)
Available from: 2025-01-14 Created: 2025-01-14 Last updated: 2025-01-14Bibliographically approved
Forssten, M. P., Mohammad Ismail, A., Ioannidis, I., Ribeiro, M. A. F., Cao, Y., Sarani, B. & Mohseni, S. (2024). Prioritizing patients for hip fracture surgery: the role of frailty and cardiac risk. Frontiers in Surgery, 11, Article ID 1367457.
Open this publication in new window or tab >>Prioritizing patients for hip fracture surgery: the role of frailty and cardiac risk
Show others...
2024 (English)In: Frontiers in Surgery, E-ISSN 2296-875X, Vol. 11, article id 1367457Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: The number of patients with hip fractures continues to rise as the average age of the population increases. Optimizing outcomes in this cohort is predicated on timely operative repair. The aim of this study was to determine if patients with hip fractures who are frail or have a higher cardiac risk suffer from an increased risk of in-hospital mortality when surgery is postponed >24 h.

METHODS: All patients registered in the 2013-2021 TQIP dataset who were ≥65 years old and underwent surgical fixation of an isolated hip fracture caused by a ground-level fall were included. Adjustment for confounding was performed using inverse probability weighting (IPW) while stratifying for frailty with the Orthopedic Frailty Score (OFS) and cardiac risk using the Revised Cardiac Risk Index (RCRI). The outcome was presented as the absolute risk difference in in-hospital mortality.

RESULTS: A total of 254,400 patients were included. After IPW, all confounders were balanced. A delay in surgery was associated with an increased risk of in-hospital mortality across all strata, and, as the degree of frailty and cardiac risk increased, so too did the risk of mortality. In patients with OFS ≥4, delaying surgery >24 h was associated with a 2.33 percentage point increase in the absolute mortality rate (95% CI: 0.57-4.09, p = 0.010), resulting in a number needed to harm (NNH) of 43. Furthermore, the absolute risk of mortality increased by 4.65 percentage points in patients with RCRI ≥4 who had their surgery delayed >24 h (95% CI: 0.90-8.40, p = 0.015), resulting in a NNH of 22. For patients with OFS 0 and RCRI 0, the corresponding NNHs when delaying surgery >24 h were 345 and 333, respectively.

CONCLUSION: Delaying surgery beyond 24 h from admission increases the risk of mortality for all geriatric hip fracture patients. The magnitude of the negative impact increases with the patient's level of cardiac risk and frailty. Operative intervention should not be delayed based on frailty or cardiac risk.

Place, publisher, year, edition, pages
Frontiers Media S.A., 2024
Keywords
Cardiac risk, frailty, hip fracture, mortality, risk stratification, surgical delay, surgical prioritization
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-112623 (URN)10.3389/fsurg.2024.1367457 (DOI)001189732600001 ()38525320 (PubMedID)2-s2.0-85202999882 (Scopus ID)
Available from: 2024-03-26 Created: 2024-03-26 Last updated: 2025-01-20Bibliographically approved
Trivedi, D., Forssten, M. P., Cao, Y., Mohammad Ismail, A., Czeiter, E., Amrein, K., . . . Mohseni, S. (2024). Screening Performance of S100 Calcium-Binding Protein B, Glial Fibrillary Acidic Protein, and Ubiquitin C-Terminal Hydrolase L1 for Intracranial Injury Within Six Hours of Injury and Beyond. Journal of Neurotrauma, 41(3-4), 349-358
Open this publication in new window or tab >>Screening Performance of S100 Calcium-Binding Protein B, Glial Fibrillary Acidic Protein, and Ubiquitin C-Terminal Hydrolase L1 for Intracranial Injury Within Six Hours of Injury and Beyond
Show others...
2024 (English)In: Journal of Neurotrauma, ISSN 0897-7151, E-ISSN 1557-9042, Vol. 41, no 3-4, p. 349-358Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: The Scandinavian NeuroTrauma Committee (SNC) guidelines recommend S100B as a screening tool for early detection of Traumatic brain injury (TBI) in patients presenting with an initial Glasgow coma scale (GCS) of 14-15. The objective of the current study was to compare S100B's diagnostic performance within the recommended 6-hour window after injury, compared to GFAP and UCH-L1. The secondary outcome of interest was the ability of these biomarkers in detecting traumatic intracranial pathology beyond the 6-hour mark.

METHODS: The Center-TBI core database (2014-2017) was queried for data pertaining to all TBI patients with an initial GCS of 14-15 who had a blood sample taken within 6 hours of injury in which the levels of S100B, GFAP, and UCH-L1 were measured. As a subgroup analysis, data involving patients with blood samples taken within 6-9 hours, and 9-12 hours were analyzed separately for diagnostic ability. The diagnostic ability of these biomarkers for detecting any intracranial injury was evaluated based on the area under the receiver operating characteristic curve (AUC). Each biomarker's sensitivity, specificity, and accuracy were also reported at the cutoff that maximized Youden's index.

RESULTS: A total of 531 TBI patients with GCS 14-15 on admission had a blood sample taken within 6 hours, of whom 24.9% (N = 132) had radiologically confirmed intracranial injury. The AUCs of GFAP (0.86, 95% confidence interval (CI): 0.82-0.90) and UCH-L1 (0.81, 95% CI: 0.76-0.85) were statistically significantly higher than that of S100B (0.74, 95% CI: 0.69-0.79) during this time. There was no statistically significant difference in the predictive ability of S100B when sampled within 6 hours, 6-9 hours, and 9-12 hours of injury, as the p-values were >0.05 when comparing the AUCs. Overlapping AUC 95% CI suggests no benefit of a combined GFAP and UCH-L1 screening tool over GFAP during the time periods studied [ 0.87 (0.83-0.90) vs 0.86 (0.82-0.90) when sampled within 6 hours of injury, 0.83 (0.78-0.88) vs 0.83 (0.78-0.89) within 6-to-9 hours and 0.81 (0.73-0.88) vs 0.79 (0.72-0.87) within 9-12 hours].

CONCLUSIONS: Targeted analysis of the CENTER-TBI core database, with focus on the patient category for which biomarker testing is recommended by the SNC guidelines, revealed that GFAP and UCH-L1 perform superior to S100B in predicting CT-positive intracranial lesions within 6 hours of injury. GFAP continued to exhibit superior predictive ability to S100B during the time periods studied. S100B displayed relatively unaltered screening performance beyond the diagnostic timeline provided by SNC guidelines. These findings suggest the need for a re-evaluation of the current SNC TBI guidelines.

Place, publisher, year, edition, pages
Mary Ann Liebert, 2024
Keywords
biomarkers, head trauma, screening, traumatic brain injury
National Category
Neurology
Identifiers
urn:nbn:se:oru:diva-110462 (URN)10.1089/neu.2023.0322 (DOI)001155701500005 ()38115670 (PubMedID)2-s2.0-85184280856 (Scopus ID)
Funder
EU, FP7, Seventh Framework Programme, FP7/2007-2013
Note

The research leading to these results was supported by the European Union's Seventh Framework Program (FP7/2007-2013) under grant agreement no 602150 (CENTER-TBI). Additional funding was obtained from the Hannelore Kohl Stiftung (Germany), from One Mind(USA), Integra Life Sciences (USA), and Neuro Trauma Sciences (US) and, Stroke for bundet, (SE).

Available from: 2023-12-21 Created: 2023-12-21 Last updated: 2024-04-02Bibliographically approved
Mohammad Ismail, A., Forssten, M. P., Sarani, B., Ribeiro, M. A. F., Chang, P., Cao, Y., . . . Mohseni, S. (2024). Sex disparities in adverse outcomes after surgically managed isolated traumatic spinal injury. European Journal of Trauma and Emergency Surgery, 50(1), 149-155
Open this publication in new window or tab >>Sex disparities in adverse outcomes after surgically managed isolated traumatic spinal injury
Show others...
2024 (English)In: European Journal of Trauma and Emergency Surgery, ISSN 1863-9933, E-ISSN 1863-9941, Vol. 50, no 1, p. 149-155Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Traumatic spinal injury (TSI) encompasses a wide range of injuries affecting the spinal cord, nerve roots, bones, and soft tissues that result in pain, impaired mobility, paralysis, and death. There is some evidence suggesting that women may have different physiological responses to traumatic injury compared to men; therefore, this study aimed to investigate if there are any associations between sex and adverse outcomes following surgically managed isolated TSI.

METHODS: Using the 2013-2019 TQIP database, all adult patients with isolated TSI, defined as a spine AIS ≥ 2 with an AIS ≤ 1 in all other body regions, resulting from blunt force trauma requiring spinal surgery, were eligible for inclusion in the study. The association between the sex and in-hospital mortality as well as cardiopulmonary and venothromboembolic complications was determined by calculating the risk ratio (RR) after adjusting for potential confounding using inverse probability weighting.

RESULTS: A total of 43,756 patients were included. After adjusting for potential confounders, female sex was associated with a 37% lower risk of in-hospital mortality [adjusted RR (95% CI): 0.63 (0.57-0.69), p < 0.001], a 27% lower risk of myocardial infarction [adjusted RR (95% CI): 0.73 (0.56-0.95), p = 0.021], a 37% lower risk of cardiac arrest [adjusted RR (95% CI): 0.63 (0.55-0.72), p < 0.001], a 34% lower risk of deep vein thrombosis [adjusted RR (95% CI): 0.66 (0.59-0.74), p < 0.001], a 45% lower risk of pulmonary embolism [adjusted RR (95% CI): 0.55 (0.46-0.65), p < 0.001], a 36% lower risk of acute respiratory distress syndrome [adjusted RR (95% CI): 0.64 (0.54-0.76), p < 0.001], a 34% lower risk of pneumonia [adjusted RR (95% CI): 0.66 (0.60-0.72), p < 0.001], and a 22% lower risk of surgical site infection [adjusted RR (95% CI): 0.78 (0.62-0.98), p < 0.032], compared to male sex.

CONCLUSION: Female sex is associated with a significantly decreased risk of in-hospital mortality as well as cardiopulmonary and venothromboembolic complications following surgical management of traumatic spinal injuries. Further studies are needed to elucidate the cause of these differences.

Place, publisher, year, edition, pages
Urban und Vogel Medien und Medizin Verlagsgesellschaft, 2024
Keywords
Equity, Morbidity, Mortality, Sex disparity, Spinal injury
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-105972 (URN)10.1007/s00068-023-02275-z (DOI)000988380100001 ()37191713 (PubMedID)2-s2.0-85159594761 (Scopus ID)
Funder
Örebro University
Available from: 2023-05-17 Created: 2023-05-17 Last updated: 2024-03-22Bibliographically approved
Ioannidis, I., Forssten, M. P., Mohammad Ismail, A., Cao, Y., Tennakoon, L., Spain, D. A. & Mohseni, S. (2024). The relationship and predictive value of dementia and frailty for mortality in patients with surgically managed hip fractures. European Journal of Trauma and Emergency Surgery, 50(2), 339-345
Open this publication in new window or tab >>The relationship and predictive value of dementia and frailty for mortality in patients with surgically managed hip fractures
Show others...
2024 (English)In: European Journal of Trauma and Emergency Surgery, ISSN 1863-9933, E-ISSN 1863-9941, Vol. 50, no 2, p. 339-345Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Both dementia and frailty have been associated with worse outcomes in patients with hip fractures. However, the interrelation and predictive value of these two entities has yet to be clarified. The current study aimed to investigate the predictive relationship between dementia, frailty, and in-hospital mortality after hip fracture surgery.

METHODS: All patients registered in the 2019 National Inpatient Sample Database who were 50 years or older and underwent emergency hip fracture surgery following a traumatic fall were eligible for inclusion. Logistic regression (LR) models were constructed with in-hospital mortality as the response variables. One model was constructed including markers of frailty and one model was constructed excluding markers of frailty [Orthopedic Frailty Score (OFS) and weight loss]. The feature importance of all variables was determined using the permutation importance method. New LR models were then fitted using the top ten most important variables. The area under the receiver-operating characteristic curve (AUC) was used to compare the predictive ability of these models.

RESULTS: An estimated total of 216,395 patients were included. Dementia was the 7th most important variable for predicting in-hospital mortality. When the OFS and weight loss were included, they replaced dementia in importance. There was no significant difference in the predictive ability of the models when comparing the model that included markers of frailty [AUC for in-hospital mortality (95% CI) 0.79 (0.77-0.81)] with the model that excluded markers of frailty [AUC for in-hospital mortality (95% CI) 0.79 (0.77-0.80)].

CONCLUSION: Dementia functions as a surrogate for frailty when predicting in-hospital mortality in hip fracture patients. This finding highlights the importance of early frailty screening for improvement of care pathways and discussions with patients and their families in regard to expected outcomes.

Place, publisher, year, edition, pages
Urban und Vogel Medien und Medizin Verlagsgesellsc, 2024
Keywords
Dementia, Frailty, Hip fracture, In-hospital mortality, Prediction
National Category
Geriatrics
Identifiers
urn:nbn:se:oru:diva-108033 (URN)10.1007/s00068-023-02356-z (DOI)001056976500001 ()37656179 (PubMedID)2-s2.0-85169315058 (Scopus ID)
Funder
Örebro University
Available from: 2023-09-04 Created: 2023-09-04 Last updated: 2024-05-06Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-3436-1026

Search in DiVA

Show all publications