The number of femoral bone fracture has grown at an accelerating speed around the world with the increasing number of elderly people. Mortality after hip fracture surgery has attracted much attention. However, easy prediction tool for mortality of patients receiving hip bone fracture surgery has not existed and explored.
Serum albumin plays significant roles such as ligand, transport protein in human body. Its level is a useful tool to assess nutritional state and liver function [Citation1]. And perioperative malnutrition is strongly associated with sepsis, infectious diseases, pressure ulcer, wound healing, length of stay and medical costs during hospitalization. In particular, serum albumin level is known as a prognostic and diagnostic marker for 1-year mortality in the patients receiving hip bone surgery [Citation2]. And also in gastrointestinal surgery, nutritional supplementary management for enteric fistula is essential. Serum albumin level is a predictive factor for healing enteric fistula [Citation3]. CRP (C-reactive protein), produced in liver and a key chemical mediator in inflammatory pathway, has been widely used since it was found by Tillet in 1930. Remarkably, CRP plays an important role in inflammation as a prognostic factor [Citation4].
From these points, to evaluate combination of serum CRP and albumin value in 1-year follow-up is novel and effective because they are inverse value in elderly population who are undergoing hemiarthroplasty due to hip fracture. Additionally, CRP/albumin ratio may predict perioperative serious complications, i.e., aspiration pneumonia, urinary retention. On this account, it is desirable to describe comorbidities and note correlation between perioperative complications and 1-year mortality in the article entitled “C-reactive protein to albumin ratio may predict mortality for elderly population who undergoing hemiarthroplasty due to hip fracture” [Citation5].
It is well known that waiting time for operation is a risk factor for perioperative complications and mortality [Citation6]. Delay for surgery results in perioperative complications. Therefore, whole body management conducted by multidisciplinary cooperation is of much importance.
Providing new insights into risk factors for perioperative complications and multidisciplinary project, we have reported low albumin, functional decline and cognitive impairments are independent components for aspiration pneumonia and urinary retention in the elderly people undergoing hip bone surgery.
These complications are crucial to the elderly receiving hip bone surgery, resulting in decreasing mobility. Low albumin, functional decline, cognitive impairments are risk factors for postoperative aspiration pneumonia and urinary retention [Citation7, Citation8].
How do we reduce mortality of patients receiving hip bone fracture surgery after discharge? From viewpoint as a geriatrician, its key factor is orthogeriatrics.We share Toyama Municipal Hospital with approximately 600 beds, where for the first time co-management (multidisciplinary management) was introduced in Japan and hip fracture surgery has been carried out by well-trained staffs within average 48 h.
To reduce perioperative complications, multidisciplinary intervention by orthopedic surgeons and geriatricians into perioperative phase is effective without negatively affecting major patients outcomes in Toyama Municipal Hospital.
On admission, cooperating with medical staffs, geriatricians at an orthopedic ward should comprehensively check physical examination, laboratory test, radioactive images, cardiovascular test, cognitive impairment, swallowing ability and fall risk-induced drugs [Citation9–11]. Regarding polypharmacy (multieffectdrugs medication), geriatricians must avoid and reduce useless drugs while patients are in hospitalization. And rehabilitation and nutritional intervention after hip bone surgery are
essential.
Co-management by geriatricians and orthopedic surgeons as well as advanced technology in orthopedics will be expected to be rigorously installed into all facilities conducting hip fracture surgery in order to improve quality of life of the patients.
Disclosure statement
No potential conflict of interest was reported by the author(s).
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