Andre Moreira Fogaça de Souza1, Abner Macola1, David Nicoletti Gumieiro2, Gustavo Augusto Nicolodi1, Rodrigo Moreira E Lima3, Marcos Ferreira Minicucci4, Paula Schmidt Azevedo5, Opinder Sahota6, Lais Helena Navarro E Lima1,3. 1. Anesthesiology Department, Botucatu Medical School, São Paulo State University, Botucatu, Brazil. 2. Surgery and Orthopedic Department, Botucatu Medical School, São Paulo State University, UNESP, Botucatu, Brazil. 3. Anesthesiology Department, Queen's University, Kingston, Canada. 4. Internal Medicine Department, Botucatu Medical School, São Paulo State University, UNESP, Rubiao Junior s/n, Botucatu, SP, CEP, 18618-970, Brazil. marcos.minicucci@unesp.br. 5. Internal Medicine Department, Botucatu Medical School, São Paulo State University, UNESP, Rubiao Junior s/n, Botucatu, SP, CEP, 18618-970, Brazil. 6. Orthogeriatric Medicine, University of Nottingham, Nottingham, UK.
Abstract
PURPOSE: The incidence of hip fractures is increasing exponentially due to an aging Brazilian population. Older people had significant comorbidities which increases the risk of post-operative mortality. Our purpose was to examine the association between pre-operative infections and comorbidities on the risk of post-operative in-hospital mortality after proximal femur fracture surgery's, beyond that, to evaluate the association between comorbidities and time to surgery. METHODS: This is a population-based cohort retrospective study, using medical records of all six year consecutive surgical procedures for correction of hip fracture in a tertiary teaching Hospital in Brazil. The exclusion criteria aimed to exclusively allocate patients who had their first hip fracture secondary to low-energy trauma. Multivariate logistical regression was performed and receiver operating characteristic (ROC) curve with area under curve (AUC) to evaluate the sensitivity and specificity of the model. p-value < 0.05 was considered significant. RESULTS: Final sample was composed by 856 consecutive patients with 81 years of median and 164 patients were excluded. The median length of hospital say was five days with - l mortality at 3.6%. Significant variables for increased mortality included the presence of pre-operative infection (odds ratio (OR): 3.9(1.12-8.54), chronic obstructive pulmonary disease (COPD) (OR: 3.83(1.36-10.82)), and systemic arterial hypertension (SAH) (OR: 4.1(1.18-14.25)). Development of pre-operative infection was associated with a delay to surgery (OR: 1.1 (1.08-1.13)). CONCLUSIONS: In older people with proximal femur fracture, the presence of pre-operative infection, COPD and SAH were the strongest risk factor for post-operative in-hospital mortality. Pre-operative infection was associated with statistically significant delay to surgery.
PURPOSE: The incidence of hip fractures is increasing exponentially due to an aging Brazilian population. Older people had significant comorbidities which increases the risk of post-operative mortality. Our purpose was to examine the association between pre-operative infections and comorbidities on the risk of post-operative in-hospital mortality after proximal femur fracture surgery's, beyond that, to evaluate the association between comorbidities and time to surgery. METHODS: This is a population-based cohort retrospective study, using medical records of all six year consecutive surgical procedures for correction of hip fracture in a tertiary teaching Hospital in Brazil. The exclusion criteria aimed to exclusively allocate patients who had their first hip fracture secondary to low-energy trauma. Multivariate logistical regression was performed and receiver operating characteristic (ROC) curve with area under curve (AUC) to evaluate the sensitivity and specificity of the model. p-value < 0.05 was considered significant. RESULTS: Final sample was composed by 856 consecutive patients with 81 years of median and 164 patients were excluded. The median length of hospital say was five days with - l mortality at 3.6%. Significant variables for increased mortality included the presence of pre-operative infection (odds ratio (OR): 3.9(1.12-8.54), chronic obstructive pulmonary disease (COPD) (OR: 3.83(1.36-10.82)), and systemic arterial hypertension (SAH) (OR: 4.1(1.18-14.25)). Development of pre-operative infection was associated with a delay to surgery (OR: 1.1 (1.08-1.13)). CONCLUSIONS: In older people with proximal femur fracture, the presence of pre-operative infection, COPD and SAH were the strongest risk factor for post-operative in-hospital mortality. Pre-operative infection was associated with statistically significant delay to surgery.
Authors: Nicole C Wright; Anne C Looker; Kenneth G Saag; Jeffrey R Curtis; Elizabeth S Delzell; Susan Randall; Bess Dawson-Hughes Journal: J Bone Miner Res Date: 2014-11 Impact factor: 6.741
Authors: Ulf Sennerby; Håkan Melhus; Rolf Gedeborg; Liisa Byberg; Hans Garmo; Anders Ahlbom; Nancy L Pedersen; Karl Michaëlsson Journal: JAMA Date: 2009-10-21 Impact factor: 56.272
Authors: Richard Ofori-Asenso; Ken L Chin; Mohsen Mazidi; Ella Zomer; Jenni Ilomaki; Andrew R Zullo; Danijela Gasevic; Zanfina Ademi; Maarit J Korhonen; Dina LoGiudice; J Simon Bell; Danny Liew Journal: JAMA Netw Open Date: 2019-08-02