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Your search keyword '"Gert R. Roukema"' showing total 6 results
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6 results on '"Gert R. Roukema"'

1. Validation of the Charlson Comorbidity Index for the prediction of 30-day and 1-year mortality among patients who underwent hip fracture surgery

Author

Eveline de Haan, Benthe van Oosten, Veronique. A. J. I. M. van Rijckevorsel, T. Martijn Kuijper, Louis de Jong, and Gert R. Roukema

Subjects
Surgery, RD1-811
Abstract

Abstract Introduction The aim of our study was to validate the original Charlson Comorbidity Index (1987) (CCI) and adjusted CCI (2011) as a prediction model for 30-day and 1-year mortality after hip fracture surgery. The secondary aim of this study was to verify each variable of the CCI as a factor associated with 30-day and 1-year mortality. Methods A prospective database of two-level II trauma teaching hospitals in the Netherlands was used. The original CCI from 1987 and the adjusted CCI were calculated based on medical history. To validate the original CCI and the adjusted CCI, the CCI was plotted against the observed 30-day and 1-year mortality, and the area under the curve (AUC) was calculated. Results A total of 3523 patients were included in this cohort study. The mean of the original CCI in this cohort was 5.1 (SD ± 2.0) and 4.6 (SD ± 1.9) for the adjusted CCI. The AUCs of the prediction models were 0.674 and 0.696 for 30-day mortality for the original and adjusted CCIs, respectively. The AUCs for 1-year mortality were 0.705 and 0.717 for the original and adjusted CCIs, respectively. Conclusions A higher original and adjusted CCI is associated with a higher mortality rate. The AUC was relatively low for 30-day and 1-year mortality for both the original and adjusted CCIs compared to other prediction models for hip fracture patients in our cohort. The CCI is not recommended for the prediction of 30-day and 1-year mortality in hip fracture patients.

Published
2024
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2. Recovery and functional outcome after radial nerve palsy in adults with a humeral shaft fracture: a multicenter prospective case series

Author

Saskia H. Van Bergen, BSc, Esther M.M. Van Lieshout, PhD, MSc, Michael H.J. Verhofstad, MD, PhD, Dennis Den Hartog, MD, PhD, Ivo Beetz, MD, PhD, Hugo W. Bolhuis, MD, P. Koen Bos, MD, PhD, Maarten W.G.A. Bronkhorst, MD, PhD, Milko M.M. Bruijninckx, MD, Jeroen De Haan, MD, PhD, Axel R. Deenik, MD, PhD, P. Ted Den Hoed, MD, PhD, Martin G. Eversdijk, MD, J. Carel Goslings, MD, PhD, Robert Haverlag, MD, Martin J. Heetveld, MD, PhD, Albertus J.H. Kerver, MD, PhD, Karel A. Kolkman, MD, Peter A. Leenhouts, MD, MBA, Kiran C. Mahabier, MD, PhD, Sven A.G. Meylaerts, MD, PhD, Ron Onstenk, MD, Martijn Poeze, MD, PhD, Rudolf W. Poolman, MD, PhD, Bas J. Punt, MD, Ewan D. Ritchie, MD, W. Herbert Roerdink, MD, PhD, Gert R. Roukema, MD, Jan Bernard Sintenie, MD, Nicolaj M.R. Soesman, MD, Edgar J.T. Ten Holder, MD, Wim E. Tuinebreijer, MD, PhD, Maarten Van der Elst, MD, PhD, Frank H.W.M. Van der Heijden, MD, PhD, Frits M. Van der Linden, MD, Peer Van der Zwaal, MD, PhD, Jan P. Van Dijk, MD, Hans-Peter W. Van Jonbergen, MD, PhD, Egbert J.M.M. Verleisdonk, MD, PhD, Jos P.A.M. Vroemen, MD, PhD, Marco Waleboer, MD, Philippe Wittich, MD, PhD, and Wietse P. Zuidema, MD

Subjects
Fracture, Humerus, Nonoperative, Operative, Radial nerve palsy, Shaft, Orthopedic surgery, RD701-811, Diseases of the musculoskeletal system, RC925-935
Abstract

Background: The consequences of radial nerve palsy associated with a humeral shaft fracture are unclear. The aim of this study was to examine the functional recovery of radial nerve palsy, at presentation or postoperatively, in patients with a humeral shaft fracture. Methods: Data from patients who participated in the HUMeral shaft fractures: measuring recovery after operative versus non-operative treatment (HUMMER) study, a multicenter prospective cohort study including adults with a closed humeral shaft fracture Arbeitsgemeinschaft für Osteosynthesefragen (AO) type 12A or 12B, and had radial nerve palsy at presentation or postoperatively, were extracted from the HUMMER database. The primary outcome measure was clinically assessed recovery of motor function of the radial nerve. Secondary outcomes consisted of treatment, functional outcome (Disabilities of the Arm, Shoulder, and Hand and Constant–Murley Score), pain level, quality of life (Short Form-36 and EuroQoL-5D-3L), activity resumption, and range of motion of the shoulder and elbow joint at 12 months after trauma. Results: Three of the 145 nonoperatively treated patients had radial nerve palsy at presentation. One recovered spontaneously and 1 after osteosynthesis. Despite multiple surgical interventions, the third patient had no recovery after entrapment between fracture fragments. Thirteen of the 245 operatively treated patients had radial nerve palsy at presentation; all recovered. Nine other patients had postoperative radial nerve palsy; 8 recovered. One had ongoing recovery at the last follow-up, after nerve release and suture repair due to entrapment under the plate. At 12 months, the functional outcome scores of all patients suggested full recovery regarding functional outcome, pain, quality of life, activity resumption, and range of motion. Conclusion: Radial nerve palsy in patients with a humeral shaft fracture at presentation or postoperatively functionally recovers in 94% and 89%, respectively.

Published
2023
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3. Delirium After Surgery for Proximal Femoral Fractures in the Frail Elderly Patient: Risk Factors and Clinical Outcomes

Author

Eveline de Haan, Veronique AJIM van Rijckevorsel, Pepijn Bod, Gert R Roukema, and Louis de Jong

Subjects
Clinical Interventions in Aging, General Medicine, Geriatrics and Gerontology
Abstract

Eveline de Haan,1,2 Veronique AJIM van Rijckevorsel,1 Pepijn Bod,1 Gert R Roukema,1 Louis de Jong1 On behalf of Dutch Hip Fracture Registry Collaboration (DHFR)1Surgery Department, Maasstad Hospital, Rotterdam, the Netherlands; 2Surgery Department, Franciscus Hospital, Rotterdam, the NetherlandsCorrespondence: Eveline de Haan, Tel +31654922535, Email e.eveline.de.haan@gmail.comPurpose: The primary aim of this study was to identify risk factors for delirium after hip fracture surgery. The secondary purpose of this study was to verify peri-operative clinical outcomes, adverse events and mortality rates in delirium patients after hip fracture surgery.Patients and Methods: A prospective hip fracture database was used to obtain data. In total, 2051 patients older than 70 years undergoing a hip fracture surgery between 01– 01-2018 and 01– 01-2021 were included. A delirium was diagnosed by a geriatrician based on the DSM-V criteria.Results: The results showed that 16% developed a delirium during hospital admission. Multivariable analysis showed that male gender (OR: 1.99, p< 0.001), age (OR: 1.06, p< 0.001), dementia (OR: 1.66, p=0.001), Parkinson’s disease (OR: 2.32, p=0.001), Δhaemoglobin loss (OR: 1.19, p=0.022), pneumonia (OR: 3.86, p< 0.001), urinary tract infection (UTI) (OR: 1.97, p=0.001) and wound infection (OR: 3.02, p=0.007) were significant independent prognostic risk factors for the development of a delirium after hip surgery. The median length in-hospital stay was longer in patients with a delirium (9 days) vs patients without a delirium (6 days) (p< 0.001). The 30-day mortality was 7% (with delirium 16% vs with no delirium 6% (p< 0.001)).Conclusion: Significant independent prognostic factors associated with delirium after hip surgery were male gender, age, dementia, Parkinson’s disease, Δhaemoglobin loss, pneumonia, UTI and wound infection.Keywords: geriatric patients, hip fractures, delirium, risk factors, clinical outcomes

Published
2023

4. Influence of time to surgery on clinical outcomes in elderly hip fracture patients

Author

Veronique A J I M, van Rijckevorsel, Louis, de Jong, Michael H J, Verhofstad, Gert R, Roukema, T M, Kuijper, and Surgery

Subjects
Pressure Ulcer, Hip Fractures, Humans, Orthopedics and Sports Medicine, Surgery, Postoperative Period, Length of Stay, Femoral Fractures, Aged
Abstract

Aims Factors associated with high mortality rates in geriatric hip fracture patients are frequently unmodifiable. Time to surgery, however, might be a modifiable factor of interest to optimize clinical outcomes after hip fracture surgery. This study aims to determine the influence of postponement of surgery due to non-medical reasons on clinical outcomes in acute hip fracture surgery. Methods This observational cohort study enrolled consecutively admitted patients with a proximal femoral fracture, for which surgery was performed between 1 January 2018 and 11 January 2021 in two level II trauma teaching hospitals. Patients with medical indications to postpone surgery were excluded. A total of 1,803 patients were included, of whom 1,428 had surgery < 24 hours and 375 had surgery ≥ 24 hours after admission. Results Prolonged total length of stay was found when surgery was performed ≥ 24 hours (median 6 days (interquartile range (IQR) 4 to 9) vs 7 days (IQR 5 to 10); p = 0.001) after admission. No differences in postoperative length of hospital stay nor in 30-day mortality rates were found. In subgroup analysis for time frames of 12 hours each, pressure sores and urinary tract infections were diagnosed more frequently when time to surgery increased. Conclusion Longer time to surgery due to non-medical reasons was associated with a higher incidence of postoperative pressure sores and urinary tract infections when time to surgery was more than 48 hours after admission. No association was found between time to surgery and 30-day mortality rates or postoperative length of hospital stay. Cite this article: Bone Joint J 2022;104-B(12):1369–1378.

Published
2022

6. Clinical outcomes of tranexamic acid in acute hip hemiarthroplasties in frail geriatric patients

Author

Veronique A J I M, van Rijckevorsel, Gert R, Roukema, Tjallingius M, Kuijper, and Louis, de Jong

Subjects
Hematoma, Hip Fractures, Arthroplasty, Replacement, Hip, Frail Elderly, Blood Loss, Surgical, Antifibrinolytic Agents, Hemoglobins, Tranexamic Acid, Thromboembolism, Humans, Orthopedics and Sports Medicine, Surgery, Hemiarthroplasty, Aged
Abstract

Tranexamic acid (TXA) has shown to significantly reduce perioperative blood loss in elective orthopedic joint replacement surgery but is yet not implemented in acute hip fracture surgery for elderly patients who are particularly vulnerable to perioperative blood loss and postoperative anemia. Aim of this study is to answer the following questions: 1. Does TXA reduce bleeding associated complications in elderly patients? 2. Does TXA induce thromboembolic complications in elderly patients?TXA reduces perioperative blood loss and associated complications in acute hip fracture surgery in geriatric patients.In this observational cohort study with prospectively enrolled patients over 65 years of age who received an acute hip hemiarthroplasty, the primary outcome was blood loss, also described as Δ hemoglobin. Secondary outcomes were bleeding associated complications as hematomas. Also, the occurrence of thromboembolic events and mortality were examined.In total 864 geriatric patients were included of which 235 received TXA and 629 did not. Multivariable analysis showed reduced Δ hemoglobin loss [-0.24 (-0.39; -0.09), p=0.002] and hematomas (OR 0.44 (0.21; 0.91), p=0.026). Pulmonary embolism were diagnosed more frequently after administration of TXA (2% versus 0.3%, p=0.008), without an association with increased 30-day mortality rate (6% versus 8%, p=0.3).TXA reduced perioperative blood loss and associated complications. However, adverse effects of TXA as pulmonary embolisms were found more frequently without effecting postoperative mortality rates. More research is needed to assess adverse effects of intravenous TXA and topical TXA as an alternative for systemic TXA to prevent systemic adverse effects.III, Observational cohort study.

Published
2022

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