Negrete-Corona J, Alvarado-Soriano JC, Reyes-Santiago LA

Language: Spanish
References: 21
Page: 352-362
PDF size: 170.99 Kb.

ABSTRACT

Introduction: Hip fracture among older patients is a devastating injury in most cases. It profoundly affects the physical, mental, functional and social balance that patients used to have and, beyond the orthopedic injury, it reflects the aging process and its dire consequences. Some reports show that up to 50% of patients with hip fracture die within six months and many of those who survive do not recover their baseline independence and function. In recent decades the increase in life expectancy after 60 years of age has led to an exponential growth in hip fractures. This is why it is essential to determine the patient-related and environmental factors leading to the increased mortality rates seen in patients with hip fracture, to improve the survival and quality of life of older adults. The objective was to determine the association between hip fracture and mortality in patients over 65 years of age. Material and methods: An observational, longitudinal, retrospective, descriptive, comparative case-control study was conducted. The clinical records of all patients over 65 years of age admitted to the Orthopedics Service, Hospital Regional «Lic. Adolfo López Mateos», ISSSTE, with a diagnosis of hip fracture during the previous 12 months were analyzed, regardless of the type of fracture and treatment they received. A group of patients without hip fracture was used as control group. Total sample size was 50 patients with hip fracture and 50 patients without hip fracture. The following data were collected in data collection forms: age, sex, time elapsed since the fracture, survival at one year and, in the case of deceased patients, the cause of death (pneumonia, sepsis, arrhythmia, hydroelectrolytic imbalance, heart failure and others). The results obtained are shown as tables and charts to facilitate their visual understanding. Results: Patient demographics show that there were 40 (80%) female patients and 10 (20%) male patients with a diagnosis of hip fracture. The control group included 35 (70%) females and 15 (30) males. An association between hip fracture and increased mortality was found, with a significant p value of 0.001. The main cause of death among hip fracture patients in our study was sepsis in 7 (35%), while among the control group it was myocardial infarction in 3 (15%). Time wise, mortality was found to be higher within the first six months, with 10 deaths (50%), and within the first year, with six deaths (30%). Discussion: Hip fracture is in fact a risk factor associated with mortality among patients over 65 years of age. Females are the group most prone to sustaining a hip fracture and, therefore, to increased mortality rates. The major cause of death among our patient population was sepsis, apparently caused by mismanagement of soft tissues, a poor aseptic technique during the surgical procedure, a long hospital stay or a poor family support network, and dementia, which is related to poor surgical wound care. The highest mortality rates were found in ages over 90 years, and they were associated with preexisting chronic-degenerative conditions. The age group at highest risk of hip fracture was 80-89 years. Patients with hip fracture should always be managed together with the internist and the geriatrician and they should be considered as orthopedic emergencies, as a long hospital stay and delayed surgical treatment are associated with major complications and increased mortality rates.

REFERENCES

1. Vestergaard P, Rejnmark L: Increased mortality in patients with a hip fracture-effect of pre-morbid conditions and postfracture complication. Osteoporos Int. 2007; 18: 1583-93.

2. Brauer CA, Coca-Perraillon M, Cutler DM, Rosen AB: Incidence and mortality of hip fractures in the United States. JAMA. 2009; 302(14): 1573-9.

3. Dzupa V, Bartonícek J, Skála-Rosenbaum J, Príkazský V: Mortality in patients with proximal femoral fractures during the first year after the injury. Acta Chir Orthop Traumatol Cech. 2002; 69(1): 39-44.

4. Kopp L, Edelmann K, Obruba P, Procházka B, Blstáková K, Dzupa V: Mortality risk factors in the elderly with proximal femoral fracture treated surgically. Acta Chir Orthop Traumatol Cech. 2009; 76(1): 41-6.

5. Moran CG, Wenn RT, Sikand M, Taylor AM: Early mortality after hip fracture is delay before surgery important? J Bone Joint Surg Am. 2005; 87A(3): 483-9.

6. Rocher JJW, Wenn RT: Effect of comorbidities and postoperative complication on mortality after hip fracture in elderly people: prospective observational cohort study. BMJ. 2005; 10(116): 1-5.

7. Söderqvist A, Miedel R, Ponzer S, Tidermark J: The influence of cognitive function on outcome after a hip fracture. J Bone Joint Surg Am. 2006; 88A(10): 2115-23.

8. Heikkinen T, Partanen J, Ristiniemi J, Jalovaara P: Evaluation of 238 consecutive patients with extended data set of the Standardised Audit for Hip Fractures in Europe (SAHFE). Disabil Rehabil. 2005; 27(18-19): 1107-15.

9. Donegan DJ, Gay AN, Baldwin K, Morales EE, Esterhai JL Jr, Mehta S: Use of medical comorbidities to predict complication after hip fracture surgery in the elderly. J Bone Joint Surg Am. 2010; 92: 807-13.

10. Navarrete F, Baixauli E: Fracturas de cadera con tratamiento conservador estudio epidemiológico. Rev Ort Traum. 2001; 45: 222.

11. Ma RS, Zhang Y, Huang X, Zhu D, Gu GS, Yang GT, et al: Causes of death after hip fracture in senile patients. Chin J Traumatol. 2012; 15(1): 42-9.

12. García S, Plaza R: Fracturas de cadera en las personas mayores de 65 ańos diagnóstico y tratamiento. JANO. 2005; 49(1574): 2-8.

13. Meyer HE, Tuerdal A: Factors associated with mortality after hip fracture. Osteop Int. 2000; 11: 228-32.

14. Nikkel LE, Fox EJ, Black KP, Davis C, Andersen L, Hollenbeak CS: Impact of comorbidities on hospitalization cost following hip fracture. J Bone Joint Surg Am. 2012; 94(4): 9-17.

15. Forsén L, Sogaard AJ, Meyer HE, Edna T, Kopjar B: Survival after hip fracture: short-and long-term excess mortality according to age and gender. Osteoporos Int. 1999; 10: 73-8.

16. Oztürk I, Toker S, Ertürer E, Aksoy B, Seçkin F: Analysis of risk factors affecting mortality in elderly patients (aged over 65 years) operated on for hip fractures. Acta Orthop Traumatol Turc. 2008; 42(1): 16-21.

17. Onnetti J, Couturier P: Proximal femoral fractures in patients over 75 year’s vital and functional prognosis of a cohort of 78 patients followed during 2.5 years. Rev Chir Orthopaedic. 1997; 83(7): 636-44.

18. Vidal IO, Moreira-Filho DC: Hip fracture in the elderly: dose courting time from fracture to surgery or from hospital admission to surgery matter when studying in-hospital mortality? Osteoporos Int. 2009; 20: 723-9.

19. Navarrete FE, Fenollosa B: Fracturas de cadera en ancianos. Factores de riesgo de mortalidad al ańo en pacientes no intervenidos. Trauma. 2010; 21(4): 219-23.

20. Maggi S, Siviero P: A multicenter survey on profile of care for hip fracture: predictors of mortality and disability. Osteoporos Int. 2010; 21: 223-31.

21. Beloosesky Y, Hershkovitz A, Guz A, Golan H, Salai M, Weiss A: Clinical characteristics and long-term mortality of occult hip fracture elderly patients” Injury. 2010; 41: 343-7.