The effects of preoperative time to surgery on outcome in patients following femur fracture

UVOD: Prijelom bedrene kosti je najčešći prijelom u starijoj populaciji. Istraživanja na temu utjecaja trajanja prijeoperacijskog razdoblja na ishod liječenja kod prijeloma bedrene kosti imaju oprečne rezultate. Prema trenutačnim preporukama, optimalna duljina prijeoperacijskog razdoblja iznosi manje od 24h. ----- CILJ: Glavni cilj istraživanja bio je istražiti utjecaj dužine vremenskog razdoblja proteklog od prijema u bolnicu do operacijskog zahvata u bolesnika s prijelomom bedrene kosti na učestalost poslijeoperacijskih komplikacija. ----- MATERIJALI I METODE: Provedeno je retrospektivno presječno istraživanje u KB „Sveti Duh“. Podaci su prikupljeni iz medicinske dokumentacije 92 bolesnika s prijelomom bedrene kosti, a potom je napravljena analiza deskriptivnom statistikom. ----- REZULTATI: Prosječno trajanje prijeoperacijskog razdoblja iznosilo je 140,61 ± 121,28 sati. Samo 5 % bolesnika operirano je unutar 24 sata. Poslijeoperacijske komplikacije zabilježene su u 52,17 % bolesnika, a uključivale su anemiju, infekcije urinarnog sutava i hipokalijemiju. ----- ZAKLJUČAK: Između vremena do operacijskog zahvata i broja komplikacija nije nađena statistički značajna povezanost, iako je vrijeme trajanja prijeoperacijske pripreme značajno duže od preporučenih 24 sata.INTRODUCTION: Femur fracure is the most often bone fracture in elderly. Studies done on the topic of association of time to surgery and postoperative complications are contradictory. Current guidelines suggest that the operation should be done in the first 24 hours from hospital admission. ----- OBJECTIVE: To examine the association of time to surgery with postoperative complications. ----- DESIGN: Cross-sectional retrospective study was performed in Clinical hospital “Sveti Duh“. Data were collected from medical reports from 92 patients with femure fracture. ----- RESULTS: Mean time to surgery was 140,61 ± 121,28 hours. Postoperative complications were reported in 52,17 % patients from which the most often were anemia, urinary tract infections and hypokalemia. ----- CONCLUSION: We found no statistically significant correlation between the preoperative time to surgery and postoperative complications, although time to surgery was longer then recommended 24 hours

The effects of preoperative time to surgery on outcome in patients following femur fracture

UVOD: Prijelom bedrene kosti je najčešći prijelom u starijoj populaciji. Istraživanja na temu utjecaja trajanja prijeoperacijskog razdoblja na ishod liječenja kod prijeloma bedrene kosti imaju oprečne rezultate. Prema trenutačnim preporukama, optimalna duljina prijeoperacijskog razdoblja iznosi manje od 24h. ----- CILJ: Glavni cilj istraživanja bio je istražiti utjecaj dužine vremenskog razdoblja proteklog od prijema u bolnicu do operacijskog zahvata u bolesnika s prijelomom bedrene kosti na učestalost poslijeoperacijskih komplikacija. ----- MATERIJALI I METODE: Provedeno je retrospektivno presječno istraživanje u KB „Sveti Duh“. Podaci su prikupljeni iz medicinske dokumentacije 92 bolesnika s prijelomom bedrene kosti, a potom je napravljena analiza deskriptivnom statistikom. ----- REZULTATI: Prosječno trajanje prijeoperacijskog razdoblja iznosilo je 140,61 ± 121,28 sati. Samo 5 % bolesnika operirano je unutar 24 sata. Poslijeoperacijske komplikacije zabilježene su u 52,17 % bolesnika, a uključivale su anemiju, infekcije urinarnog sutava i hipokalijemiju. ----- ZAKLJUČAK: Između vremena do operacijskog zahvata i broja komplikacija nije nađena statistički značajna povezanost, iako je vrijeme trajanja prijeoperacijske pripreme značajno duže od preporučenih 24 sata.INTRODUCTION: Femur fracure is the most often bone fracture in elderly. Studies done on the topic of association of time to surgery and postoperative complications are contradictory. Current guidelines suggest that the operation should be done in the first 24 hours from hospital admission. ----- OBJECTIVE: To examine the association of time to surgery with postoperative complications. ----- DESIGN: Cross-sectional retrospective study was performed in Clinical hospital “Sveti Duh“. Data were collected from medical reports from 92 patients with femure fracture. ----- RESULTS: Mean time to surgery was 140,61 ± 121,28 hours. Postoperative complications were reported in 52,17 % patients from which the most often were anemia, urinary tract infections and hypokalemia. ----- CONCLUSION: We found no statistically significant correlation between the preoperative time to surgery and postoperative complications, although time to surgery was longer then recommended 24 hours

INTEREST IN CHOOSING RESIDENCY IN ANESTHESIOLOGY AMONG SIXTH-YEAR MEDICAL STUDENTS AT THE SCHOOL OF MEDICINE, UNIVERSITY OF ZAGREB

Cilj ovog ispitivanja je određivanje interesa za specijalizaciju iz anesteziologije, reanimatologije i intenzivne medicine među studentima šeste godine Medicinskog fakulteta Sveučilišta u Zagrebu. Provedeno je anonimnom anketom na uzorku od 232 studenata. Istraženi su razlozi odabira navedene specijalizacije kao i razlozi nezainteresiranosti. Petnaest (8,15 %) ispitanika navelo je specijalizaciju iz anesteziologije, reanimatologije i intenzivne medicine kao svoj prvi izbor, dok ih je sveukupno 29 (5,48 %) navelo ovu specijalizaciju unutar prva tri izbora. Utvrđen je veći interes za ovu specijalizaciju u odnosu na ranije provedena istraživanja. Ispitanici koji su odabrali specijalizaciju iz anesteziologije kao izrazito bitne razloge za ovaj odabir navode da su uz teorijsko znanje važne i manualne vještine, dok kao najmanje bitan razlog navode tvrdnju da nema dugoročnog praćenja pacijenata. Ispitanici koji nisu odabrali ovu specijalizaciju kao glavne razloge za to navode stres i da se osobno ne vide u ovoj struci. Vrijednost našeg ispitivanja je u identifi ciranju glavnih čimbenika koji su potencijalni cilj djelovanja mjera za smanjivanje odlaska anesteziologa u inozemstvo i povećanja interesa za ovu specijalizaciju.The aim of this research was to determine the level of interest in residency in anesthesiology among sixth-year students at the School of Medicine, University of Zagreb. An anonymous questionnaire was administered to 269 students. We analyzed the reasons for and against choosing this residency. Fifteen (8.15%) students declared residency in anesthesiology as their first choice and 29 (5.48%) students declared it as one of their top three choices. These results indicated a higher level of interest in this residency as compared with previous studies. Students who chose residency in anesthesiology indicated theoretical knowledge and manual skills as significant factors in making that choice while the least significant factor was the lack of long-term patient follow up. Students who did not choose this residency indicated stress and lack of personal interest as the main reasons for making this decision. The value of this research lies in identifying the main factors that can be used as potential targets for measures against emigration of anesthesiologists and increasing student interest in this residency

Epidemiological characteristics, baseline clinical features, and outcomes of critically ill patients treated in a coronavirus disease 2019 tertiary center in continental Croatia

Aim To describe epidemiological characteristics and base - line clinical features, laboratory findings at intensive care unit (ICU) admission, and survival rates of critically ill coro - navirus disease 2019 (COVID-19) patients treated at a ter - tiary institution specialized for COVID-19 patients. Methods This retrospective study recruited 692 patients (67.1% men). Baseline demographic data, major comorbid - ities, anthropometric measurements, clinical features, and laboratory findings at admission were compared between survivors and non-survivors. Results The median age was 72 (64-78) years. The median body mass index was 29.1 kg/m 2 . The most relevant comor - bidities were diabetes mellitus (32.6%), arterial hyperten - sion (71.2%), congestive heart failure (19.1%), chronic kid - ney disease (12.6%), and hematological disorders (10.3%). The median number of comorbidities was 3 and median Charlson Comorbidity Index (CCI) was 5. A total of 61.8% patients received high-flow nasal oxygen therapy (HFNO) and 80.5% received mechanical ventilation (MV). Median duration of HFNO was 3, and that of MV was 7 days. ICU mortality rate was 72.7%. Survivors had significantly lower age, number of comorbidities, CCI, sequential organ failure assessment score, serum ferritin, C-reactive protein, D-dim - er, and procalcitonin, interleukin-6, lactate, white blood cell, and neutrophil counts. They also had higher lymphocyte counts, Pa O 2 /FiO 2 ratio, and glomerular filtration rate at ad - mission. Length of ICU stay was 9 days. The median surviv - al was 11 days for mechanically ventilated patients, and 24 days for patients who were not mechanically ventilated. Conclusion The parameters that differentiate survivors from non-survivors are in agreement with published data. Further multivariate analyses are warranted to identify in - dividual mortality risk factor

Bacterial superinfections in critically ill COVID-19 patients – experiences from University Hospital Dubrava tertiary COVID-19 center

Cilj istraživanja: Utvrditi incidenciju najčešćih bakterijskih superinfekcija, distribuciju uzročnika ovisno o sijelu infekcije, demografske podatke, relevantne laboratorijske i kliničke parametre te ishode liječenja kritično oboljelih bolesnika liječenih u tercijarnom regionalnom centru specijaliziranom za liječenje COVID-19 bolesnika PRIC KB Dubrava. Ispitanici i metode: Provedeno je retrospektivno opservacijsko ispitivanje te su podaci skupljeni pregledom povijesti bolesti u bolničkom informacijskom sustavu (BIS, In2, Zagreb) pacijenata liječenih u jedinicama intenzivne medicine PRIC-IC KB Dubrava tijekom razdoblja od 01. ožujka 2020. do 01. veljače 2021. Skupljeni podaci analizirani su u statističkom programskom paketu jamovi. Rezultati: Od ukupno 692 pacijenta, 383 je razvilo bakterijsku ili gljivičnu superinfekciju. Njih 305 je razvilo pneumoniju, 133 bakterijemiju a 120 urinarnu infekciju. 66,3% pacijenata bilo je muškog spola, te su češće primani sa bolničkih odjela i JIM-ova drugih bolnica. Od 305 pacijenata sa pneumonijom 295 je bilo mehanički ventilirano te je razvilo VAP. Kod pacijenata koji nisu razvili bakterijemiju primjećen je porat omjera neutrofili leukociti, te limfopenija i pad vrijednosti CRP-a. Urinarna infekcija češća je kod žena. U sve tri skupine, pacijenti su imali produljen period boravka u JIM-u i u bolnici. Zaključci: Incidencija bakterijskih superinfekcija u kritično oboljelih COVID-19 pacijenata vrlo je visoka i iznosi 55,3%. Najčešće bakterijske superinfekcije su VAP, bakterijemija i urinarna infekcija. Najčešći uzročni patogeni su MDR bakterije. Pacijenti sa sekundarnom infekcijom imaju dulji period boravka u JIM. Povećanje omjera neutrofili / limfociti i progresija limfopenije povezane su sa nepovoljnim kliničkim ishodima.Goal: To determine incidence of bacterial superinfections, causative pathogens demographic data, relevant laboratory parameters and outcomes in critically ill COVID-19 patients treated in primary respiratory intensivist center (PRIC) UH Dubrava. Patients and methods: In this retrospective observational study, clinical and laboratory data of 692 critically ill patients treated in PRIC UH Dubrava between March 1st 2020. and February 1st 2021. was collected using the hospital information system software (BIS) and statistical analysis was performed using the jamovi statistical package. Results: Out of 692 patients admitted to the ICU, 383 acquired bacterial or fungal superinfections. 305 acquired pneumonia, 133 bloodstream infections and 120 urinary infections. 66.3% of patients were males, and bacterial superinfections were more common in patients admitted from hospital wards or external ICUs. Out of 305 patients with pneumonia, 295 were receiving mechanical ventilation and satisfied the criteria for ventilator associated pneumonia. Patients with bloodstream infections maintained elevated neutrophil lymphocyte ratio, lymphopenia and elevated CRP levels on day 7 compared to those without BSI. Urinary infections were more common in females, and did not have an effect on outcomes. All patients that developed superinfections had prolonged ICU and hospital stay. Conclusion: Incidence of bacterial superinfections in critically ill COVID-19 patients is 55.3%. Most common infections are ventilator associated pneumonia, bloodstream infections and urinary infections. Most common pathogens are multi-drug resistant pathogens. Patients with bacterial superinfections have longer ICU and hospital stay, and in these patients, persistent elevation of NLR ratio and worsening of lymphopenia are characteristic for patients with worse outcomes

Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (fo

The effects of preoperative time to surgery on outcome in patients following femur fracture

UVOD: Prijelom bedrene kosti je najčešći prijelom u starijoj populaciji. Istraživanja na temu utjecaja trajanja prijeoperacijskog razdoblja na ishod liječenja kod prijeloma bedrene kosti imaju oprečne rezultate. Prema trenutačnim preporukama, optimalna duljina prijeoperacijskog razdoblja iznosi manje od 24h. ----- CILJ: Glavni cilj istraživanja bio je istražiti utjecaj dužine vremenskog razdoblja proteklog od prijema u bolnicu do operacijskog zahvata u bolesnika s prijelomom bedrene kosti na učestalost poslijeoperacijskih komplikacija. ----- MATERIJALI I METODE: Provedeno je retrospektivno presječno istraživanje u KB „Sveti Duh“. Podaci su prikupljeni iz medicinske dokumentacije 92 bolesnika s prijelomom bedrene kosti, a potom je napravljena analiza deskriptivnom statistikom. ----- REZULTATI: Prosječno trajanje prijeoperacijskog razdoblja iznosilo je 140,61 ± 121,28 sati. Samo 5 % bolesnika operirano je unutar 24 sata. Poslijeoperacijske komplikacije zabilježene su u 52,17 % bolesnika, a uključivale su anemiju, infekcije urinarnog sutava i hipokalijemiju. ----- ZAKLJUČAK: Između vremena do operacijskog zahvata i broja komplikacija nije nađena statistički značajna povezanost, iako je vrijeme trajanja prijeoperacijske pripreme značajno duže od preporučenih 24 sata.INTRODUCTION: Femur fracure is the most often bone fracture in elderly. Studies done on the topic of association of time to surgery and postoperative complications are contradictory. Current guidelines suggest that the operation should be done in the first 24 hours from hospital admission. ----- OBJECTIVE: To examine the association of time to surgery with postoperative complications. ----- DESIGN: Cross-sectional retrospective study was performed in Clinical hospital “Sveti Duh“. Data were collected from medical reports from 92 patients with femure fracture. ----- RESULTS: Mean time to surgery was 140,61 ± 121,28 hours. Postoperative complications were reported in 52,17 % patients from which the most often were anemia, urinary tract infections and hypokalemia. ----- CONCLUSION: We found no statistically significant correlation between the preoperative time to surgery and postoperative complications, although time to surgery was longer then recommended 24 hours

Epidemiological characteristics, baseline clinical features, and outcomes of critically ill patients treated in a coronavirus disease 2019 tertiary center in continental Croatia

Aim: To describe epidemiological characteristics and baseline clinical features, laboratory findings at intensive care unit (ICU) admission, and survival rates of critically ill coronavirus disease 2019 (COVID-19) patients treated at a tertiary institution specialized for COVID-19 patients. ----- Methods: This retrospective study recruited 692 patients (67.1% men). Baseline demographic data, major comorbidities, anthropometric measurements, clinical features, and laboratory findings at admission were compared between survivors and non-survivors. ----- Results: The median age was 72 (64-78) years. The median body mass index was 29.1 kg/m2. The most relevant comorbidities were diabetes mellitus (32.6%), arterial hypertension (71.2%), congestive heart failure (19.1%), chronic kidney disease (12.6%), and hematological disorders (10.3%). The median number of comorbidities was 3 and median Charlson Comorbidity Index (CCI) was 5. A total of 61.8% patients received high-flow nasal oxygen therapy (HFNO) and 80.5% received mechanical ventilation (MV). Median duration of HFNO was 3, and that of MV was 7 days. ICU mortality rate was 72.7%. Survivors had significantly lower age, number of comorbidities, CCI, sequential organ failure assessment score, serum ferritin, C-reactive protein, D-dimer, and procalcitonin, interleukin-6, lactate, white blood cell, and neutrophil counts. They also had higher lymphocyte counts, PaO2/FiO2 ratio, and glomerular filtration rate at admission. Length of ICU stay was 9 days. The median survival was 11 days for mechanically ventilated patients, and 24 days for patients who were not mechanically ventilated. ----- Conclusion: The parameters that differentiate survivors from non-survivors are in agreement with published data. Further multivariate analyses are warranted to identify individual mortality risk factors

Distribution of Pathogens and Predictive Values of Biomarkers of Inflammatory Response at ICU Admission on Outcomes of Critically Ill COVID-19 Patients with Bacterial Superinfections—Observations from National COVID-19 Hospital in Croatia

Background: Superinfections contribute to mortality and length of stay in critically ill COVID-19 patients. The aim of this study was to determine the incidence and pathogen distribution of bacterial and fungal superinfections of the lower respiratory tract (LRTI), urinary tract (UTI) and bloodstream (BSI) and to determine the predictive value of biomarkers of inflammatory response on their ICU survival rates. Methods: A retrospective observational study that included critically ill COVID-19 patients treated during an 11-month period in a Croatian national COVID-19 hospital was performed. Clinical and diagnostic data were analyzed according to the origin of superinfection, and multivariate regression analysis was performed to determine the predictive values of biomarkers of inflammation on their survival rates. Results: 55.3% critically ill COVID-19 patients developed bacterial or fungal superinfections, and LRTI were most common, followed by BSI and UTI. Multidrug-resistant pathogens were the most common causes of LRTI and BSI, while Enterococcus faecalis was the most common pathogen causing UTI. Serum ferritin and neutrophil count were associated with decreased chances of survival in patients with LRTI, and patients with multidrug-resistant isolates had significantly higher mortality rates, coupled with longer ICU stays. Conclusion: The incidence of superinfections in critically ill COVID-19 patients was 55.3%, and multidrug-resistant pathogens were dominant. Elevated ferritin levels and neutrophilia at ICU admission were associated with increased ICU mortality in patients with positive LRTI