Sección del ligamento transverso del carpo de forma percutánea ecoguiada vs. cirugía abierta para el tratamiento quirúrgico del síndrome del túnel del carpo (STC) / Percutaneous ultrasound-guided section of the transverse carpal ligament vs open surgery for the surgical treatment of carpal tunnel syndrome (CTS)

Antecedentes y objetivo: El gold standard del tratamiento del síndrome del túnel carpiano (STC) es la sección del ligamento transverso del carpo, siendo la técnica más común la incisión cutánea palmar. Se han desarrollados técnicas percutáneas, aunque su relación riesgo/beneficio sigue siendo controvertida. Objetivo: Analizar el resultado funcional de los pacientes intervenidos de STC de forma percutánea ecoguiada y compararlo con cirugía abierta. Material y método: Estudio de cohortes observacional prospectivo de 50 pacientes intervenidos de STC (25 percutáneos con técnica Walant y 25 por cirugía abierta con anestesia local y manguito de isquemia). La cirugía abierta se realizó mediante una incisión palmar corta. La técnica percutánea se realizó de forma anterógrada utilizando el bisturí Kemis® H3 (Newclip). Se realizó una valoración preoperatoria y postoperatoria a las dos semanas, seis semanas y tres meses. Se recogieron datos demográficos, presencia de complicaciones, fuerza de prensión y puntuación del test de Levine (BCTQ). Resultados: La muestra consta de 14 hombres y 36 mujeres con edad media de 51,4 años (IC 95%: 48,4-54,5). Todos los pacientes mejoraron de su clínica de STC sin obtener diferencias estadísticamente significativas en la puntuación BCTQ, ni en la presencia de complicaciones (p > 0,05). Los pacientes intervenidos de forma percutánea recuperaron más rápida la fuerza de prensión a las seis semanas, pero fue similar en la revisión final. Conclusiones: En vista de los resultados obtenidos, la cirugía percutánea ecoguiada es una buena alternativa para el tratamiento quirúrgico del STC. Esta técnica requiere su curva de aprendizaje y familiarización con la visualización ecográfica de las estructuras anatómicas a tratar.(AU)

Background and objective: The gold standard of carpal tunnel syndrome (CTS) treatment is the section of the transverse carpal ligament, the most common technique being the palmar cutaneous incision. Percutaneous techniques have been developed, although their risk/benefit ratio remains controversial. Objective: To analyze the functional outcome of patients undergoing CTS percutaneously ultrasound-guided and compare it with those of open surgery. Material and method: Prospective observational cohort study of 50 patients undergoing CTS (25 percutaneous with WALANT technique and 25 by open surgery with local anesthesia and tourniquet). Open surgery was performed using a short palmar incision. The percutaneous technique was performed anterograde using the Kemis® H3 scalpel (Newclip). A preoperative and postoperative assessment was performed at 2 weeks, 6 weeks and 3 months. Demographic data, presence of complications, grip strength and Levine test score (BCTQ) were collected. Results: The sample consists of 14 men and 36 women with a mean age of 51.4 years (95% CI: 48.4-54.5). Percutaneous technique was performed anterograde using the Kemis® H3 scalpel (Newclip). All patients improved from their CTS clinic without obtaining statistically significant differences in BCTQ score, nor in the presence of complications (p> 0.05). Patients operated on percutaneously recovered faster grip strength at 6 weeks, but it was similar in the final review. Conclusions: In view of the results obtained, percutaneous ultrasound-guided surgery is a good alternative for the surgical treatment of CTS. Logically, this technique requires its learning curve and familiarization with the ultrasound visualization of the anatomical structures to be treated.(AU)

[Translated article] Percutaneous ultrasound-guided section of the transverse carpal ligament vs. open surgery for the surgical treatment of carpal tunnel syndrome (CTS) / Sección del ligamento transverso del carpo de forma percutánea ecoguiada vs. cirugía abierta para el tratamiento quirúrgico del síndrome del túnel del carpo (STC)

Antecedentes y objetivo: El gold standard del tratamiento del síndrome del túnel carpiano (STC) es la sección del ligamento transverso del carpo, siendo la técnica más común la incisión cutánea palmar. Se han desarrollados técnicas percutáneas, aunque su relación riesgo/beneficio sigue siendo controvertida. Objetivo: Analizar el resultado funcional de los pacientes intervenidos de STC de forma percutánea ecoguiada y compararlo con cirugía abierta. Material y método: Estudio de cohortes observacional prospectivo de 50 pacientes intervenidos de STC (25 percutáneos con técnica Walant y 25 por cirugía abierta con anestesia local y manguito de isquemia). La cirugía abierta se realizó mediante una incisión palmar corta. La técnica percutánea se realizó de forma anterógrada utilizando el bisturí Kemis® H3 (Newclip). Se realizó una valoración preoperatoria y postoperatoria a las dos semanas, seis semanas y tres meses. Se recogieron datos demográficos, presencia de complicaciones, fuerza de prensión y puntuación del test de Levine (BCTQ). Resultados: La muestra consta de 14 hombres y 36 mujeres con edad media de 51,4 años (IC 95%: 48,4-54,5). Todos los pacientes mejoraron de su clínica de STC sin obtener diferencias estadísticamente significativas en la puntuación BCTQ, ni en la presencia de complicaciones (p > 0,05). Los pacientes intervenidos de forma percutánea recuperaron más rápida la fuerza de prensión a las seis semanas, pero fue similar en la revisión final. Conclusiones: En vista de los resultados obtenidos, la cirugía percutánea ecoguiada es una buena alternativa para el tratamiento quirúrgico del STC. Esta técnica requiere su curva de aprendizaje y familiarización con la visualización ecográfica de las estructuras anatómicas a tratar.(AU)

Background and objective: The gold standard of carpal tunnel syndrome (CTS) treatment is the section of the transverse carpal ligament, the most common technique being the palmar cutaneous incision. Percutaneous techniques have been developed, although their risk/benefit ratio remains controversial. Objective: To analyze the functional outcome of patients undergoing CTS percutaneously ultrasound-guided and compare it with those of open surgery. Material and method: Prospective observational cohort study of 50 patients undergoing CTS (25 percutaneous with WALANT technique and 25 by open surgery with local anesthesia and tourniquet). Open surgery was performed using a short palmar incision. The percutaneous technique was performed anterograde using the Kemis® H3 scalpel (Newclip). A preoperative and postoperative assessment was performed at 2 weeks, 6 weeks and 3 months. Demographic data, presence of complications, grip strength and Levine test score (BCTQ) were collected. Results: The sample consists of 14 men and 36 women with a mean age of 51.4 years (95% CI: 48.4-54.5). Percutaneous technique was performed anterograde using the Kemis® H3 scalpel (Newclip). All patients improved from their CTS clinic without obtaining statistically significant differences in BCTQ score, nor in the presence of complications (p> 0.05). Patients operated on percutaneously recovered faster grip strength at 6 weeks, but it was similar in the final review. Conclusions: In view of the results obtained, percutaneous ultrasound-guided surgery is a good alternative for the surgical treatment of CTS. Logically, this technique requires its learning curve and familiarization with the ultrasound visualization of the anatomical structures to be treated.(AU)

¿Ha influido el confinamiento social por COVID-19 en la mortalidad de la fractura de cadera? Análisis de la mortalidad al año / Has the COVID-19 lockdown influenced the mortality of hip fracture? Analysis of one-year mortality

Introducción y objetivos: El objetivo principal de este estudio es analizar la mortalidad al año en los pacientes con fractura intracapsular de cadera que ingresaron durante un severo confinamiento social en los primeros meses de la pandemia por COVID-19 y compararla con años previos. Material y método: Estudio observacional retrospectivo en el que se comparó una cohorte del 14 marzo al 21 de junio de 2020 (grupo pandemia, n = 62) con una cohorte control en las mismas fechas de los años 2017, 2018 y 2019 (grupo control, n = 172). Se midieron la mortalidad a los 30 días y al año, complicaciones ortopédicas, grado ASA, comorbilidades, diagnóstico y tratamiento, tiempo hasta cirugía y estancia hospitalaria. Resultados: No se encontraron diferencias significativas en la mortalidad a los 30 días (p = 0,156; 9,7% vs. 4,7%) ni en la mortalidad anual (p = 0,47) entre el grupo pandemia (21%) y el control (16,9%). Se objetivó un descenso de la demora quirúrgica y de la estancia media en el grupo pandemia, aunque sin significación estadística. Conclusión: El estado de alarma modificó la distribución del tipo de fractura de cadera con un predominio de la fractura intracapsular. Mantener el mismo manejo hospitalario que previo a la pandemia permitió no incrementar la mortalidad a los 30 días y al año en los pacientes con fractura intracapsular de cadera.(AU)

Introduction and objectives: The main objective of this study is to analyze the one-year mortality in patients with intracapsular hip fracture who were admitted during severe social confinement in the first months of the COVID-19 lockdown and compare it with previous years. Material and methods: Retrospective observational study in which a cohort from March 14 to June 21, 2020 (pandemic group, n = 62) was compared with a control cohort on the same dates in the years 2017, 2018 and 2019 (control group, n = 172). Thirty-day-mortality and one-year-mortality, orthopedic complications, ASA grade, comorbidities, diagnosis and treatment, time to surgery and mean stay were measured. Results: No significant differences were found in 30-day mortality (p = 0.156; 9.7% compared to 4.7%) or in one-year mortality (p = 0.47) between the pandemic group (21%) and the control one (16.9%). A decrease in surgical delay and mean stay was observed in the pandemic group, although without statistical significance. Conclusión: The State of Alarm modified the distribution of the type of hip fracture with a predominance of intracapsular fracture. Maintaining the same hospital management as prior to the pandemic period made it possible not to increase 30-day mortality and one-year mortality in patients with intracapsular hip fracture.(AU)

[Translated article] Has the COVID-19 lockdown influenced the mortality of hip fracture? Analysis of one-year mortality / ¿Ha influido el confinamiento social por COVID-19 en la mortalidad de la fractura de cadera? Análisis de la mortalidad al año

Introducción y objetivos: El objetivo principal de este estudio es analizar la mortalidad al año en los pacientes con fractura intracapsular de cadera que ingresaron durante un severo confinamiento social en los primeros meses de la pandemia por COVID-19 y compararla con años previos. Material y método: Estudio observacional retrospectivo en el que se comparó una cohorte del 14 marzo al 21 de junio de 2020 (grupo pandemia, n = 62) con una cohorte control en las mismas fechas de los años 2017, 2018 y 2019 (grupo control, n = 172). Se midieron la mortalidad a los 30 días y al año, complicaciones ortopédicas, grado ASA, comorbilidades, diagnóstico y tratamiento, tiempo hasta cirugía y estancia hospitalaria. Resultados: No se encontraron diferencias significativas en la mortalidad a los 30 días (p = 0,156; 9,7% vs. 4,7%) ni en la mortalidad anual (p = 0,47) entre el grupo pandemia (21%) y el control (16,9%). Se objetivó un descenso de la demora quirúrgica y de la estancia media en el grupo pandemia, aunque sin significación estadística. Conclusión: El estado de alarma modificó la distribución del tipo de fractura de cadera con un predominio de la fractura intracapsular. Mantener el mismo manejo hospitalario que previo a la pandemia permitió no incrementar la mortalidad a los 30 días y al año en los pacientes con fractura intracapsular de cadera.(AU)

Introduction and objectives: The main objective of this study is to analyze the one-year mortality in patients with intracapsular hip fracture who were admitted during severe social confinement in the first months of the COVID-19 lockdown and compare it with previous years. Material and methods: Retrospective observational study in which a cohort from March 14 to June 21, 2020 (pandemic group, n = 62) was compared with a control cohort on the same dates in the years 2017, 2018 and 2019 (control group, n = 172). Thirty-day-mortality and one-year-mortality, orthopedic complications, ASA grade, comorbidities, diagnosis and treatment, time to surgery and mean stay were measured. Results: No significant differences were found in 30-day mortality (p = 0.156; 9.7% compared to 4.7%) or in one-year mortality (p = 0.47) between the pandemic group (21%) and the control one (16.9%). A decrease in surgical delay and mean stay was observed in the pandemic group, although without statistical significance. Conclusión: The State of Alarm modified the distribution of the type of hip fracture with a predominance of intracapsular fracture. Maintaining the same hospital management as prior to the pandemic period made it possible not to increase 30-day mortality and one-year mortality in patients with intracapsular hip fracture.(AU)

[Translated article] Percutaneous ultrasound-guided section of the transverse carpal ligament vs. open surgery for the surgical treatment of carpal tunnel syndrome (CTS).

BACKGROUND AND OBJECTIVE: The gold standard of carpal tunnel syndrome (CTS) treatment is the section of the transverse carpal ligament, the most common technique being the palmar cutaneous incision. Percutaneous techniques have been developed, although their risk/benefit ratio remains controversial. OBJECTIVE: To analyse the functional outcome of patients undergoing CTS percutaneously ultrasound-guided and compare it with those of open surgery. MATERIAL AND METHOD: Prospective observational cohort study of 50 patients undergoing CTS (25 percutaneous with WALANT technique and 25 by open surgery with local anaesthesia and tourniquet). Open surgery was performed using a short palmar incision. The percutaneous technique was performed anterograde using the Kemis H3® scalpel (Newclip). A preoperative and postoperative assessment was performed at 2 weeks, 6 weeks and 3 months. Demographic data, presence of complications, grip strength and Levine test score (BCTQ) were collected. RESULTS: The sample consists of 14 men and 36 women with a mean age of 51.4 years (95% CI: 48.4-54.5). Percutaneous technique was performed anterograde using the Kemis H3® scalpel (Newclip). All patients improved from their CTS clinic without obtaining statistically significant differences in BCTQ score, nor in the presence of complications (p>0.05). Patients operated on percutaneously recovered faster grip strength at 6 weeks, but it was similar in the final review. CONCLUSIONS: In view of the results obtained, percutaneous ultrasound-guided surgery is a good alternative for the surgical treatment of CTS. Logically, this technique requires its learning curve and familiarisation with the ultrasound visualisation of the anatomical structures to be treated.

Has the COVID-19 lockdown influenced the mortality of hip fracture? Analysis of one-year mortality. / ¿Ha influido el confinamiento social por COVID-19 en la mortalidad de la fractura de cadera? Análisis de la mortalidad al año.

INTRODUCTION AND OBJECTIVES: The main objective of this study is to analyze the one-year mortality in patients with intracapsular hip fracture who were admitted during severe social confinement in the first months of the COVID-19 lockdown and compare it with previous years. MATERIAL AND METHODS: Retrospective observational study in which a cohort from March 14 to June 21, 2020 (pandemic group, n = 62) was compared with a control cohort on the same dates in the years 2017, 2018 and 2019 (control group, n = 172). Thirty-day-mortality and one-year-mortality, orthopedic complications, ASA grade, comorbidities, diagnosis and treatment, time to surgery and mean stay were measured. RESULTS: No significant differences were found in 30-day mortality (p = 0.156; 9.7% compared to 4.7%) or in one-year mortality (p = 0.47) between the pandemic group (21%) and the control one (16.9%). A decrease in surgical delay and mean stay was observed in the pandemic group, although without statistical significance. CONCLUSIóN: The State of Alarm modified the distribution of the type of hip fracture with a predominance of intracapsular fracture. Maintaining the same hospital management as prior to the pandemic period made it possible not to increase 30-day mortality and one-year mortality in patients with intracapsular hip fracture.

[Translated article] Has the COVID-19 lockdown influenced the mortality of hip fracture? Analysis of one-year mortality.

INTRODUCTION AND OBJECTIVES: The main objective of this study is to analyse the one-year mortality in patients with intracapsular hip fracture who were admitted during severe social confinement in the first months of the COVID-19 lockdown and compare it with previous years. MATERIAL AND METHODS: Retrospective observational study in which a cohort from March 14 to June 21, 2020 (pandemic group, n=62) was compared with a control cohort on the same dates in the years 2017, 2018 and 2019 (control group, n=172). Thirty-day-mortality and one-year-mortality, orthopaedic complications, ASA grade, comorbidities, diagnosis and treatment, time to surgery and mean stay were measured. RESULTS: No significant differences were found in 30-day mortality (p=0.156; 9.7% compared to 4.7%) or in one-year mortality (p=0.47) between the pandemic group (21%) and the control one (16.9%). A decrease in surgical delay and mean stay was observed in the pandemic group, although without statistical significance. CONCLUSION: The State of Alarm modified the distribution of the type of hip fracture with a predominance of intracapsular fracture. Maintaining the same hospital management as prior to the pandemic period made it possible not to increase 30-day mortality and one-year mortality in patients with intracapsular hip fracture.

Percutaneous ultrasound-guided section of the transverse carpal ligament vs open surgery for the surgical treatment of carpal tunnel syndrome (CTS). / Sección del ligamento transverso del carpo de forma percutánea ecoguiada vs. cirugía abierta para el tratamiento quirúrgico del síndrome del túnel del carpo (STC).

BACKGROUND AND OBJECTIVE: The gold standard of carpal tunnel syndrome (CTS) treatment is the section of the transverse carpal ligament, the most common technique being the palmar cutaneous incision. Percutaneous techniques have been developed, although their risk/benefit ratio remains controversial. OBJECTIVE: To analyze the functional outcome of patients undergoing CTS percutaneously ultrasound-guided and compare it with those of open surgery. MATERIAL AND METHOD: Prospective observational cohort study of 50 patients undergoing CTS (25 percutaneous with WALANT technique and 25 by open surgery with local anesthesia and tourniquet). Open surgery was performed using a short palmar incision. The percutaneous technique was performed anterograde using the Kemis® H3 scalpel (Newclip). A preoperative and postoperative assessment was performed at 2 weeks, 6 weeks and 3 months. Demographic data, presence of complications, grip strength and Levine test score (BCTQ) were collected. RESULTS: The sample consists of 14 men and 36 women with a mean age of 51.4 years (95% CI: 48.4-54.5). Percutaneous technique was performed anterograde using the Kemis® H3 scalpel (Newclip). All patients improved from their CTS clinic without obtaining statistically significant differences in BCTQ score, nor in the presence of complications (p> 0.05). Patients operated on percutaneously recovered faster grip strength at 6 weeks, but it was similar in the final review. CONCLUSIONS: In view of the results obtained, percutaneous ultrasound-guided surgery is a good alternative for the surgical treatment of CTS. Logically, this technique requires its learning curve and familiarization with the ultrasound visualization of the anatomical structures to be treated.

Epidemiology of Bone Fractures in the Hand in Adult Population Using the ICD-10 Classification.

PURPOSE OF THE STUDY The purpose of this study was to conduct an epidemiological study of hand fractures in adult population. MATERIAL AND METHODS A retrospective observational study in a population of 470,000 habitants was performed. Over the course of three years, all patients over 16 years of age who were diagnosed with fracture or fracture-dislocation at the level of a carpal bone, metacarpal and/or phalange were included. These fractures were classified according to the International Classification of Diseases 10th edition (ICD-10). Incidence rates, along with gender and age distribution were also studied. RESULTS 1,267 patients with a total of 1,341 hand fractures were included. They represented 29.7% of all upper limb fractures and 7.6% of all traumatological emergencies involving a bone fracture during that period. The most frequent ICD-10 group was S62.3, with the fifth metacarpal as the most often affected bone (39.7%). The most frequent location at the level of the phalanges (S62.5) was the proximal third of the proximal phalanx of the fifth radius. The global incidence rate was 99 fractures per 100,000 persons/year. No seasonal variation was observed. Only 10.2% of hand fractures received surgical treatment. DISCUSSION Several epidemiological studies have been published on fractures in the hand, but none have used the ICD-10 classification. Although the distribution of our stratified sample by age and gender was similar to those previously published, the incidence rate in our study was much lower. We may possibly extrapolate our results to the rest of the Spanish population and even to the rest of the population of southern Europe, given the scarcity of epidemiological studies on this matter in these geographical areas. CONCLUSIONS The ICD-10 classification is useful for the description and classification of hand fractures. The most often affected group is that including metacarpals of the long fingers (S62.3), being the distal level of the fifth metacarpal in young male patients the most frequent one. Most fractures are treated conservatively and in case of surgical treatment, the preferred surgical techniques include K-wire fixation, interfragmentary compression screws and plate osteosynthesis. Key words: epidemiology, incidence, fracture, fracture dislocation, carpal bones, metacarpals, finger phalanges.

Influence of integrated orthogeriatric care on morbidity and mortality and length of hospital stay for hip fracture / Influencia de la atención ortogeriátrica integrada en la morbimortalidad y el tiempo de estancia hospitalaria de la fractura de cadera

Background and objectives: Compare the morbidity and mortality, the length of hospital stay and the economic cost of the fragility fracture of the hip, in two nonconsecutive years thanks to the integrated orthogeriatric care. Material and method: Retrospective observational cohort study with 633 patients with hip fragility fracture with a mean age of 85.5 years, treated in the same Trauma and Orthopaedic Surgery service in two different years (2012 and 2017). Mean stay, surgical delay, perioperative mortality, one month and one year, and perioperative complications such as acute urine retention, pressure ulcers, and need for transfusion were measured. Results: Mortality during admission decreased from 10% in 2012 to 3.6% in 2017 (P=.004 *), while mortality at thirty days (10.5% vs 7%) (P=.123) and one year (28.9% versus 24.9%) (P=.277). Hospital stay times, surgical delay, and postoperative admission time also decreased. The estimated total annual economic savings thanks to integrated orthogeriatric care amounted to €1,017,084.94. Conclusions: Integrated orthogeriatric care of the patient with fragility fracture of the hip, results in a more effective and efficient care model. Both the care and the clinical situation of patients are improved in the perioperative period, both hospital stay and mortality during admission are significantly reduced, and all this with significant associated economic savings.(AU)

Antecedentes y objetivos: Comparar la morbimortalidad, el tiempo de estancia hospitalaria y el gasto económico de la fractura por fragilidad de cadera en 2 años no consecutivos gracias a la atención ortogeriátrica integrada. Material y método: Estudio observacional retrospectivo de cohorte con 633 pacientes con fractura por fragilidad de cadera, con una media de edad de 85,5 años, tratados en un mismo servicio de cirugía ortopédica y traumatología en 2 años diferentes (2012 y 2017). Se midieron la estancia media, la demora quirúrgica, la mortalidad perioperatoria, al mes y al año, y las complicaciones perioperatorias como la retención aguda de orina, las úlceras por presión y la necesidad de transfusión. Resultados: La mortalidad durante el ingreso disminuyó del 10% en 2012 al 3,6% en 2017 (p=0,004), a la vez que la mortalidad a los 30 días (10,5% frente a 7%) (p=0,123) y al año (28,9% frente a 24,9%) (p=0,277). También disminuyeron los tiempos de estancia hospitalaria, la demora quirúrgica y el tiempo de ingreso postoperatorio. El ahorro económico total anual estimado gracias a la atención ortogeriátrica integrada supuso 1.017.084,94€. Conclusiones: La atención ortogeriátrica integrada del paciente con fractura por fragilidad de la cadera resulta en un modelo de atención más efectivo y eficiente. Se mejora tanto la calidad asistencial como la situación clínica de los pacientes en el periodo perioperatorio, se disminuyen significativamente tanto la estancia hospitalaria como la mortalidad durante el ingreso, y todo ello con un importante ahorro económico asociado.(AU)

Influencia de la atención ortogeriátrica integrada en la morbimortalidad y el tiempo de estancia hospitalaria de la fractura de cadera / Influence of integrated orthogeriatric care on morbidity and mortality and length of hospital stay for hip fracture

Antecedentes y objetivos: Comparar la morbimortalidad, el tiempo de estancia hospitalaria y el gasto económico de la fractura por fragilidad de cadera en 2 años no consecutivos gracias a la atención ortogeriátrica integrada. Material y método: Estudio observacional retrospectivo de cohorte con 633 pacientes con fractura por fragilidad de cadera, con una media de edad de 85,5 años, tratados en un mismo servicio de cirugía ortopédica y traumatología en 2 años diferentes (2012 y 2017). Se midieron la estancia media, la demora quirúrgica, la mortalidad perioperatoria, al mes y al año, y las complicaciones perioperatorias como la retención aguda de orina, las úlceras por presión y la necesidad de transfusión. Resultados: La mortalidad durante el ingreso disminuyó del 10% en 2012 al 3,6% en 2017 (p=0,004), a la vez que la mortalidad a los 30 días (10,5% frente a 7%) (p=0,123) y al año (28,9% frente a 24,9%) (p=0,277). También disminuyeron los tiempos de estancia hospitalaria, la demora quirúrgica y el tiempo de ingreso postoperatorio. El ahorro económico total anual estimado gracias a la atención ortogeriátrica integrada supuso 1.017.084,94€. Conclusiones: La atención ortogeriátrica integrada del paciente con fractura por fragilidad de la cadera resulta en un modelo de atención más efectivo y eficiente. Se mejora tanto la calidad asistencial como la situación clínica de los pacientes en el periodo perioperatorio, se disminuyen significativamente tanto la estancia hospitalaria como la mortalidad durante el ingreso, y todo ello con un importante ahorro económico asociado.(AU)

Background and objectives: Compare the morbidity and mortality, the length of hospital stay and the economic cost of the fragility fracture of the hip, in two nonconsecutive years thanks to the integrated orthogeriatric care. Material and method: Retrospective observational cohort study with 633 patients with hip fragility fracture with a mean age of 85.5 years, treated in the same Trauma and Orthopaedic Surgery service in two different years (2012 and 2017). Mean stay, surgical delay, perioperative mortality, one month and one year, and perioperative complications such as acute urine retention, pressure ulcers, and need for transfusion were measured. Results: Mortality during admission decreased from 10% in 2012 to 3.6% in 2017 (P=.004 *), while mortality at thirty days (10.5% vs 7%) (P=.123) and one year (28.9% versus 24.9%) (P=.277). Hospital stay times, surgical delay, and postoperative admission time also decreased. The estimated total annual economic savings thanks to integrated orthogeriatric care amounted to €1,017,084.94. Conclusions: Integrated orthogeriatric care of the patient with fragility fracture of the hip, results in a more effective and efficient care model. Both the care and the clinical situation of patients are improved in the perioperative period, both hospital stay and mortality during admission are significantly reduced, and all this with significant associated economic savings.(AU)

Influence of integrated orthogeriatric care on morbidity and mortality and length of hospital stay for hip fracture. / Influencia de la atención ortogeriátrica integrada en la morbimortalidad y el tiempo de estancia hospitalaria de la fractura de cadera.

BACKGROUND AND OBJECTIVES: Compare the morbidity and mortality, the length of hospital stay and the economic cost of the fragility fracture of the hip, in two nonconsecutive years thanks to the integrated orthogeriatric care. MATERIAL AND METHOD: Retrospective observational cohort study with 633 patients with hip fragility fracture with a mean age of 85.5 years, treated in the same Trauma and Orthopaedic Surgery service in two different years (2012 and 2017). Mean stay, surgical delay, perioperative mortality, one month and one year, and perioperative complications such as acute urine retention, pressure ulcers, and need for transfusion were measured. RESULTS: Mortality during admission decreased from 10% in 2012 to 3.6% in 2017 (P=.004 *), while mortality at thirty days (10.5% vs 7%) (P=.123) and one year (28.9% versus 24.9%) (P=.277). Hospital stay times, surgical delay, and postoperative admission time also decreased. The estimated total annual economic savings thanks to integrated orthogeriatric care amounted to €1,017,084.94. CONCLUSIONS: Integrated orthogeriatric care of the patient with fragility fracture of the hip, results in a more effective and efficient care model. Both the care and the clinical situation of patients are improved in the perioperative period, both hospital stay and mortality during admission are significantly reduced, and all this with significant associated economic savings.