Functional outcomes after the treatment of hip fracture.

Osteoporotic hip fracture is a major public health issue. Estimation of the outcome and maximization of functional recovery after fracture is very important in the treatment of older patients. The purposes of this study were to clarify the functional outcomes after the treatment of hip fracture and to identify the factors that influence functional recovery. In the present study, 228 patients admitted to an acute-care hospital from January 2016 to June 2018 were evaluated. The patients were categorized into a trochanteric fracture group (n = 128) and a neck fracture group (n = 100). We retrospectively reviewed their ambulation ability 6 months after fracture using the Functional Ambulation Category (FAC) score. The other survey items were the presurgical duration, length of hospital stay, time until beginning to walk using parallel bars, complications affecting treatment, and mortality rate. The 6-month follow-up rate was 54.4% (n = 124). The results showed that the patients with trochanteric fracture were significantly older than those with neck fracture (86 vs. 82 years, respectively; p = 0.03). In total, 85.0% of patients with trochanteric fracture and 92.2% of patients with neck fracture were independent ambulators before injury (FAC score of 4 or 5). The FAC score 6 months after fracture was positively correlated with the FAC score before fracture and at discharge (all p<0.001) and negatively correlated with patient age (p<0.001) and presurgical duration for patients with neck fracture (p = 0.04). There was no statistically significant correlation with the length of hospital stay or the time until beginning to walk using parallel bars. In conclusion, patients with trochanteric fractures were older than those with neck fractures. In both fracture types, walking recovery 6 months after hip fracture was related to the FAC score before injury and at discharge from an acute-care hospital but not to the time until beginning to walk using parallel bars

Multidisciplinary team-based approach for comprehensive preoperative pulmonary rehabilitation including intensive nutritional support for lung cancer patients.

BACKGROUND: To decrease the risk of postoperative complication, improving general and pulmonary conditioning preoperatively should be considered essential for patients scheduled to undergo lung surgery. OBJECTIVE: The aim of this study is to develop a short-term beneficial program of preoperative pulmonary rehabilitation for lung cancer patients. METHODS: From June 2009, comprehensive preoperative pulmonary rehabilitation (CHPR) including intensive nutritional support was performed prospectively using a multidisciplinary team-based approach. Postoperative complication rate and the transitions of pulmonary function in CHPR were compared with historical data of conventional preoperative pulmonary rehabilitation (CVPR) conducted since June 2006. The study population was limited to patients who underwent standard lobectomy. RESULTS: Postoperative complication rate in the CVPR (n = 29) and CHPR (n = 21) were 48.3% and 28.6% (p = 0.2428), respectively. Those in patients with Charlson Comorbidity Index scores ≥2 were 68.8% (n = 16) and 27.3% (n = 11), respectively (p = 0.0341) and those in patients with preoperative risk score in Estimation of Physiologic Ability and Surgical Stress scores >0.3 were 57.9% (n = 19) and 21.4% (n = 14), respectively (p = 0.0362). Vital capacities of pre- and post intervention before surgery in the CHPR group were 2.63±0.65 L and 2.75±0.63 L (p = 0.0043), respectively; however, their transition in the CVPR group was not statistically significant (p = 0.6815). Forced expiratory volumes in one second of pre- and post intervention before surgery in the CHPR group were 1.73±0.46 L and 1.87±0.46 L (p = 0.0012), respectively; however, their transition in the CVPR group was not statistically significant (p = 0.6424). CONCLUSIONS: CHPR appeared to be a beneficial and effective short-term preoperative rehabilitation protocol, especially in patients with poor preoperative conditions

Logistic regression analyses of risk factors for postoperative complication in patients with preoperative risk score in Estimation of Physiologic Ability and Surgical Stress (PRS) >0.3 (n = 33).

<p>FEV1, forced expiratory volume in one second; VC, vital capacity; VATS, video-assisted thoracic surgery; CI, confidence interval; CHPR, comprehensive preoperative pulmonary rehabilitation; CVPR, conventional preoperative pulmonary rehabilitation.</p

Patient characteristics and clinicopathological features.

<p>CHPR, comprehensive pulmonary rehabilitation; CVPR, conventional pulmonary rehabilitation; FEV1, forced expiratory volume in one second; VC, vital capacity; VATS, video-assisted thoracic surgery; RU, right upper lobe; RM, right middle lobe; RL, right lower lobe; LU, left upper lobe; LL, left lower lobe; AD, adenocarcinoma, SQ; squamous cell carcinoma; NYHA, New York Heart Association;; CCI, Charlson Comorbidity Index; PRS, preoperative risk score in Estimation of Physiologic Ability and Surgical Stress.</p

Logistic regression analyses of risk factors for postoperative complication in all patients (n = 50).

<p>FEV1, forced expiratory volume in one second; VC, vital capacity; VATS, video-assisted thoracic surgery; CI, confidence interval; CHPR, comprehensive preoperative pulmonary rehabilitation; CVPR, conventional preoperative pulmonary rehabilitation.</p

Postoperative complication rate in all patients and subgroup analyses.

<p>CCI, Charlson Comorbidity Index; PRS, preoperative risk score in Estimation of Physiologic Ability and Surgical Stress; CHPR, comprehensive preoperative pulmonary rehabilitation; CVPR, conventional preoperative pulmonary rehabilitation.</p

Definition of postoperative complication after lung resection.

*<p>According to the Common Terminology Criteria for Adverse Events (version 4).</p

Transitions of pulmonary function after CHPR (A) and CVPR (B).

<p>A statistically significant beneficial effect was observed for CHPR. CHPR, comprehensive pulmonary rehabilitation; CVPR, conventional pulmonary rehabilitation; pre, pre-intervention; post, postintervention before surgery; VC, vital capacity; FEV1.0, forced expiratory volume in one second.</p

Carlson Comorbidity Index.

<p>Carlson Comorbidity Index.</p

Estimation of Physiologic Ability and Surgical Stress scores.

<p>Estimation of Physiologic Ability and Surgical Stress scores.</p