ABSTRACT
Revisar el tratamiento perioperatorio de los pacientes con fracturas de cadera y tratamiento concomitante con antiagregantes plaquetarios, así como analizar las diferencias de mortalidad al año, y el sangrado perioperatorio según la pauta de cirugía precoz (< 48 h) vs. demorada (> 5 días). Paralelamente, determinar al ingreso y en el preoperatorio inmediato la agregabilidad plaquetaria en todos los pacientes incluidos en el estudio. Pacientes y método. Sobre 175 pacientes mayores de 65 años con fractura de cadera de baja energía se aleatorizaron 3 grupos: antiagregados con cirugía precoz, antiagregados con cirugía demorada, y no antiagregados con cirugía precoz; se recogieron prospectivamente los mismos datos clínicos y analíticos para todos ellos. La agregabilidad plaquetaria se determinó mediante un sistema informatizado semicuantitativo basado en la agregometría por impedancia en sangre completa. Resultados. El sangrado, los requerimientos transfusionales y los resultados analíticos no mostraron diferencias estadísticamente significativas entre los grupos. Un 59,8% de los pacientes que no referían tomar antiagregantes se encontraban analíticamente antiagregados al ingreso, mientras que un 13,5% de los que tomaban antiagregantes no se encontraban correctamente antiagregados. El análisis multivariante mostró mayor mortalidad a 12 meses para las variables del índice de Barthel bajo previo a la fractura (OR: 0,9-0,9) y número de transfusiones (OR: 1,1-1,5). La estancia media fue de 4,1 días mayor en el grupo demorado. Conclusión. La pauta de cirugía precoz para los pacientes en tratamiento antiagregante tiene resultados clínicos parecidos a la demorada, pero mejora la eficiencia hospitalaria al reducir la estancia media. La antiagregación farmacológica referida por el paciente resultó poco concordante con la determinación de la agregabilidad(AU)
Objective. A review of the perioperative management of patients with hip fractures and concomitant therapy with antiplatelet agents, and to analyse the differences in mortality and perioperative bleeding in early surgery (<48 h) versus delayed surgery (>5 days). Platelet aggregation was measured on admission and immediately before surgery in all patients included in the study. Patients and methods. A total of 175 patients over 65 years old, with low energy hip fracture were randomised into 3 groups: Patients on antiplatelet therapy undergoing early surgery, patients on antiplatelet therapy undergoing delayed surgery, and patients not on antiplatelet therapy undergoing early surgery. The same clinical and laboratory data were collected prospectively up to 12 months for all the patients. The platelet aggregation was determined by a semi-quantitative computerised system based on impedance aggregometry in whole blood. Results. Bleeding, transfusion requirements and analytical results showed no significant differences between groups. More than half (59.8%) of the patients not taking antiplatelet therapy had normal platelet aggregation on admission, while 13.5% of those taking antiplatelet agents did not. Multivariate analysis showed increased mortality at 12 months for the variables, low Barthel index before hip fracture (OR: 0.9-0.9) and number of transfusions (OR: 1.1-1.5). The average lenth of stay was 4.1 days greater in the delayed surgery group. Conclusion. Early surgery for patients receiving antiplatelet therapy has similar clinical outcomes to the delayed, but improves hospital efficiency by reducing the average length of stay. The antiplatelet drug reported by the patient showed low concordance with the determination of the platelet aggregation(AU)
Subject(s)
Humans , Male , Female , /rehabilitation , Hip Fractures/surgery , Hip Fractures/therapy , Hip Fractures , Hip Prosthesis/trends , Platelet Aggregation Inhibitors/metabolism , Platelet Aggregation Inhibitors/therapeutic use , Hip Fractures/physiopathology , Platelet Function Tests , Platelet Aggregation , Platelet Aggregation/physiology , Perioperative Period/methodsABSTRACT
OBJECTIVE: A review of the perioperative management of patients with hip fractures and concomitant therapy with antiplatelet agents, and to analyse the differences in mortality and perioperative bleeding in early surgery (<48 h) versus delayed surgery (>5 days). Platelet aggregation was measured on admission and immediately before surgery in all patients included in the study PATIENTS AND METHODS: A total of 175 patients over 65 years old, with low energy hip fracture were randomised into 3 groups: Patients on antiplatelet therapy undergoing early surgery, patients on antiplatelet therapy undergoing delayed surgery, and patients not on antiplatelet therapy undergoing early surgery. The same clinical and laboratory data were collected prospectively up to 12 months for all the patients. The platelet aggregation was determined by a semi-quantitative computerised system based on impedance aggregometry in whole blood. RESULTS: Bleeding, transfusion requirements and analytical results showed no significant differences between groups. More than half (59.8%) of the patients not taking antiplatelet therapy had normal platelet aggregation on admission, while 13.5% of those taking antiplatelet agents did not. Multivariate analysis showed increased mortality at 12 months for the variables, low Barthel index before hip fracture (OR: 0.9-0.9) and number of transfusions (OR: 1.1-1.5). The average lenth of stay was 4.1 days greater in the delayed surgery group. CONCLUSION: Early surgery for patients receiving antiplatelet therapy has similar clinical outcomes to the delayed, but improves hospital efficiency by reducing the average length of stay. The antiplatelet drug reported by the patient showed low concordance with the determination of the platelet aggregation.
Subject(s)
Hip Fractures/surgery , Platelet Aggregation Inhibitors/therapeutic use , Aged, 80 and over , Early Medical Intervention , Female , Hip Fractures/blood , Hip Fractures/mortality , Humans , Male , Platelet Aggregation , Prospective Studies , Time FactorsABSTRACT
OBJECTIVES: To identify patients at greater risk of developing respiratory complications, defined as the need for mechanical ventilation (MV) longer than 48 h, following revascularization surgery. MATERIAL AND METHODS: This was a prospective analysis of 39 variables in 107 consecutive operations taking place over 9 months. We studied the association of these variables with the need for prolonged MV after surgery, by way of single variable and multivariate analysis. RESULTS: The incidence of prolonged MV was 7.7% and the 25% rate of mortality in the group of patients with this complication was significantly higher than the 0% mortality in the remaining patients. After single variable analysis of the data, the following variables were more significantly (p < 0.01) associated with the need for postoperative MV longer than 48 h: presence of other cardiac lesions other than coronary disease, performance of other heart surgery along with the coronary revascularization, surgical complications, high left auricular pressure soon after surgery. The variables found to have the highest independent predictive value based on the multivariate analysis were performance of other heart surgery along with the coronary revascularization and surgical complications. CONCLUSION: Our study indicates that the variables that point to poor left ventricular function and negative repercussions on extracorporeal circulation are associated with a greater incidence of prolonged MV after coronary surgery. Keeping these variables in mind allows high risk patients to be identified. More extensive monitoring of breathing function and therapeutic measures can then be implemented for better postoperative management.