title: Bone cement implantation syndrome in cemented hemiarthroplasty for femoral neck fracture: incidence, risk factors, and effect on outcome.
abstract: BACKGROUND
  Bone cement implantation syndrome (BCIS) is characterized by hypoxia, hypotension, and loss of consciousness occurring around the time of bone cementation. Using a recently proposed severity classification of BCIS, we estimated the incidence of and risk factors for BCIS and its impact on mortality in cemented hemiarthroplasty for femoral neck fractures.
  
  
  METHODS
  In this retrospective study, 1016 patients undergoing cemented hemiarthroplasty were included. Medical history and medication were obtained from medical records. Anaesthesia charts for all patients were reviewed for mean arterial pressure, arterial oxygen saturation, and heart rate before, during, and after cementation. Each patient was classified as having no BCIS (grade 0) or BCIS grade 1, 2, or 3, depending on the degree of hypotension, arterial desaturation, or loss of consciousness around cementation.
  
  
  RESULTS
  The incidence of BCIS grade 1, 2, and 3 were 21%, 5.1%, and 1.7%, respectively. Early mortality in BCIS grade 1 (9.3%) did not differ significantly from BCIS grade 0 (5.2%), while early mortality in BCIS grade 2 (35%) and grade 3 (88%) were significantly higher when compared with grades 0 and 1. Early mortality was also higher in BCIS grade 3 when compared with grade 2. Independent predictors for severe BCIS were: ASA grade III-IV, chronic obstructive pulmonary disease, and medication with diuretics or warfarin. Severe BCIS was associated with 16-fold increase in mortality.
  
  
  CONCLUSIONS
  BCIS is a commonly occurring phenomenon in cemented hemiarthroplasty and severe BCIS has a huge impact on early and late mortality.
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: F
authors.initials: F
authors.lastname: Olsen
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: M
authors.initials: M
authors.lastname: Kotyra
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: E
authors.initials: E
authors.lastname: Houltz
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden sven-erik.ricksten@aniv.gu.se.
authors.forename: S-E
authors.initials: SE
authors.lastname: Ricksten
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001178:Arthroplasty / Q000009:adverse effects* / Q000401:mortality; D001843:Bone Cements / Q000009:adverse effects*; D005260:Female; D005265:Femoral Neck Fractures / Q000401:mortality / Q000601:surgery*; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects; D012307:Risk Factors; D016019:Survival Analysis; D013577:Syndrome; D016896:Treatment Outcome
chemical_list: D001843:Bone Cements
keywords: bone cement implantation syndrome; femoral neck fracture; hemiarthroplasty; outcome; risk factors