Association of Brain Natriuretic Peptide Levels at Time of Injury with Morbidity and Mortality in Patients with Surgically Treated Hip Fractures
Background:. An elevated brain natriuretic peptide (BNP) level has been shown to be associated with mortality and cardiac events in cardiac surgery, but its utility in the prediction of morbidity and mortality in hip fracture surgery is unknown. The primary aim of this study was to determine if ther...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer
2023-06-01
|
| Series: | JBJS Open Access |
| Online Access: | http://journals.lww.com/jbjsoa/fulltext/10.2106/JBJS.OA.22.00102 |
| _version_ | 1797817482129440768 |
|---|---|
| author | Brian Joseph Page, MD Jessica Lahre Hughes, MD Jon Martin Walsh, MD Lauren Nicole Stimson, MD Kendall Pye Hammonds, MPH Kindyle Losey Brennan, PhD, PT Daniel Lee Stahl, MD Michael Lee Brennan, MD |
| author_facet | Brian Joseph Page, MD Jessica Lahre Hughes, MD Jon Martin Walsh, MD Lauren Nicole Stimson, MD Kendall Pye Hammonds, MPH Kindyle Losey Brennan, PhD, PT Daniel Lee Stahl, MD Michael Lee Brennan, MD |
| author_sort | Brian Joseph Page, MD |
| collection | DOAJ |
| description | Background:. An elevated brain natriuretic peptide (BNP) level has been shown to be associated with mortality and cardiac events in cardiac surgery, but its utility in the prediction of morbidity and mortality in hip fracture surgery is unknown. The primary aim of this study was to determine if there is a difference in BNP level at the time of injury between patients who do and do not develop complications after hip fracture surgery. The secondary aim was to determine if there is a predictive relationship between complications associated with the initial BNP level and mortality.
Methods:. A retrospective chart review of 455 hip fractures in patients ≥60 years old that were operatively treated between February 2014 and July 2018 was performed. Patients were included if they had a BNP level within 48 hours after injury (BNPi). Specific perioperative (≤7 days), 30-day, 1-year, and 2-year postoperative complications were recorded. Wilcoxon rank-sum tests were used to determine if higher BNPi values were associated with greater morbidity. The complications associated with higher BNPi values were further analyzed to assess if they were predictive of mortality, using univariate and multivariable analyses.
Results:. Higher BNPi was significantly associated with greater morbidity at all postoperative time points and with higher mortality at 1 and 2 years postoperatively. Furthermore, several complications including cardiac failure or exacerbation and altered mental status were associated with mortality at all time points in univariate analysis and at many time points in multivariable analysis.
Conclusions:. Patients with higher BNPi levels were more likely to develop complications up to 1 year postoperatively, and several of these complications were associated with increased mortality. Future studies to determine if delaying surgery until BNP levels are normalized or lowered may help guide management, and may be useful in determining the need for further medical optimization. Future studies aimed at defining a threshold BNP value at the time of injury may also help in better managing patients preoperatively.
Level of Evidence:. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence. |
| first_indexed | 2024-03-13T08:54:05Z |
| format | Article |
| id | doaj.art-2cb2863ec555434d8b4b83ccc9bb2acd |
| institution | Directory Open Access Journal |
| issn | 2472-7245 |
| language | English |
| last_indexed | 2024-03-13T08:54:05Z |
| publishDate | 2023-06-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | JBJS Open Access |
| spelling | doaj.art-2cb2863ec555434d8b4b83ccc9bb2acd2023-05-29T03:41:19ZengWolters KluwerJBJS Open Access2472-72452023-06-018210.2106/JBJS.OA.22.00102JBJSOA2200102Association of Brain Natriuretic Peptide Levels at Time of Injury with Morbidity and Mortality in Patients with Surgically Treated Hip FracturesBrian Joseph Page, MD0Jessica Lahre Hughes, MD1Jon Martin Walsh, MD2Lauren Nicole Stimson, MD3Kendall Pye Hammonds, MPH4Kindyle Losey Brennan, PhD, PT5Daniel Lee Stahl, MD6Michael Lee Brennan, MD71 Limb Lengthening and Complex Reconstruction, Hospital for Special Surgery, New York, NY3 UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania4 Department of Orthopedic Surgery, Baylor Scott & White Health, Temple, Texas5 Department of Orthopedic Surgery, Detroit Medical Center, Detroit, Michigan6 Baylor Scott & White Health, Temple, Texas7 Doctor of Physical Therapy Program, Mayborn College of Health Professions, University of Mary Hardin-Baylor, Belton, Texas4 Department of Orthopedic Surgery, Baylor Scott & White Health, Temple, Texas8 Trauma Section, Department of Orthopedic Surgery, Baylor Scott & White Health, Temple, TexasBackground:. An elevated brain natriuretic peptide (BNP) level has been shown to be associated with mortality and cardiac events in cardiac surgery, but its utility in the prediction of morbidity and mortality in hip fracture surgery is unknown. The primary aim of this study was to determine if there is a difference in BNP level at the time of injury between patients who do and do not develop complications after hip fracture surgery. The secondary aim was to determine if there is a predictive relationship between complications associated with the initial BNP level and mortality. Methods:. A retrospective chart review of 455 hip fractures in patients ≥60 years old that were operatively treated between February 2014 and July 2018 was performed. Patients were included if they had a BNP level within 48 hours after injury (BNPi). Specific perioperative (≤7 days), 30-day, 1-year, and 2-year postoperative complications were recorded. Wilcoxon rank-sum tests were used to determine if higher BNPi values were associated with greater morbidity. The complications associated with higher BNPi values were further analyzed to assess if they were predictive of mortality, using univariate and multivariable analyses. Results:. Higher BNPi was significantly associated with greater morbidity at all postoperative time points and with higher mortality at 1 and 2 years postoperatively. Furthermore, several complications including cardiac failure or exacerbation and altered mental status were associated with mortality at all time points in univariate analysis and at many time points in multivariable analysis. Conclusions:. Patients with higher BNPi levels were more likely to develop complications up to 1 year postoperatively, and several of these complications were associated with increased mortality. Future studies to determine if delaying surgery until BNP levels are normalized or lowered may help guide management, and may be useful in determining the need for further medical optimization. Future studies aimed at defining a threshold BNP value at the time of injury may also help in better managing patients preoperatively. Level of Evidence:. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.http://journals.lww.com/jbjsoa/fulltext/10.2106/JBJS.OA.22.00102 |
| spellingShingle | Brian Joseph Page, MD Jessica Lahre Hughes, MD Jon Martin Walsh, MD Lauren Nicole Stimson, MD Kendall Pye Hammonds, MPH Kindyle Losey Brennan, PhD, PT Daniel Lee Stahl, MD Michael Lee Brennan, MD Association of Brain Natriuretic Peptide Levels at Time of Injury with Morbidity and Mortality in Patients with Surgically Treated Hip Fractures JBJS Open Access |
| title | Association of Brain Natriuretic Peptide Levels at Time of Injury with Morbidity and Mortality in Patients with Surgically Treated Hip Fractures |
| title_full | Association of Brain Natriuretic Peptide Levels at Time of Injury with Morbidity and Mortality in Patients with Surgically Treated Hip Fractures |
| title_fullStr | Association of Brain Natriuretic Peptide Levels at Time of Injury with Morbidity and Mortality in Patients with Surgically Treated Hip Fractures |
| title_full_unstemmed | Association of Brain Natriuretic Peptide Levels at Time of Injury with Morbidity and Mortality in Patients with Surgically Treated Hip Fractures |
| title_short | Association of Brain Natriuretic Peptide Levels at Time of Injury with Morbidity and Mortality in Patients with Surgically Treated Hip Fractures |
| title_sort | association of brain natriuretic peptide levels at time of injury with morbidity and mortality in patients with surgically treated hip fractures |
| url | http://journals.lww.com/jbjsoa/fulltext/10.2106/JBJS.OA.22.00102 |
| work_keys_str_mv | AT brianjosephpagemd associationofbrainnatriureticpeptidelevelsattimeofinjurywithmorbidityandmortalityinpatientswithsurgicallytreatedhipfractures AT jessicalahrehughesmd associationofbrainnatriureticpeptidelevelsattimeofinjurywithmorbidityandmortalityinpatientswithsurgicallytreatedhipfractures AT jonmartinwalshmd associationofbrainnatriureticpeptidelevelsattimeofinjurywithmorbidityandmortalityinpatientswithsurgicallytreatedhipfractures AT laurennicolestimsonmd associationofbrainnatriureticpeptidelevelsattimeofinjurywithmorbidityandmortalityinpatientswithsurgicallytreatedhipfractures AT kendallpyehammondsmph associationofbrainnatriureticpeptidelevelsattimeofinjurywithmorbidityandmortalityinpatientswithsurgicallytreatedhipfractures AT kindyleloseybrennanphdpt associationofbrainnatriureticpeptidelevelsattimeofinjurywithmorbidityandmortalityinpatientswithsurgicallytreatedhipfractures AT danielleestahlmd associationofbrainnatriureticpeptidelevelsattimeofinjurywithmorbidityandmortalityinpatientswithsurgicallytreatedhipfractures AT michaelleebrennanmd associationofbrainnatriureticpeptidelevelsattimeofinjurywithmorbidityandmortalityinpatientswithsurgicallytreatedhipfractures |