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1.
Bone Joint J ; 103-B(3): 449-455, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33641426

RESUMO

AIMS: To assess the safety of tranexamic acid (TXA) in a large cohort of patients aged over 65 years who have sustained a hip fracture, with a focus on transfusion rates, mortality, and thromboembolic events. METHODS: This is a consecutive cohort study with prospectively collected registry data. Patients with a hip fracture in the Region of Southern Denmark were included over a two-year time period (2015 to 2017) with the first year constituting a control group. In the second year, perioperative TXA was introduced as an intervention. Outcome was transfusion frequency, 30-day and 90-day mortality, and thromboembolic events. The latter was defined as any diagnosis or death due to arterial or venous thrombosis. The results are presented as relative risk (RR) and hazard ratio (HR) with 95% confidence intervals (CIs). RESULTS: A total of 3,097 patients were included: 1,558 in the control group and 1,539 in the TXA group.31% (n = 477) of patients had transfusions in the control group compared to 27% (n = 405) in the TXA group yielding an adjusted RR of 0.83 (95% CI 0.75 to 0.91). TXA was not associated with increased 30-day mortality with an adjusted HR of 1.10 (95% CI 0.88 to 1.39) compared to the control group as well as no association with increased risk of 90-day mortality with a per protocol adjusted HR of 1.24 (95% CI 0.93 to 1.66). TXA was associated with a lower risk of thromboembolic events after 30 days (RR 0.63 (95% CI 0.42 to 0.93)) and 90 days (RR 0.72 (95% CI 0.52 to 0.99)). A subanalysis on haemoglobin demonstrated a median 17.7 g/L (interquartile range (IQR) 11.3 to 27.3) decrease in the control group compared to 17.7 g/L (IQR 9.7 to 25.8) in the per protocol TXA group (p = 0.060 on group level difference). CONCLUSION: TXA use in patients with a hip fracture, was not associated with an increased risk of mortality but was associated with lower transfusion rate and reduced thromboembolic events. Thus, we conclude that it is safe to use TXA in this patient group. Cite this article: Bone Joint J 2021;103-B(3):449-455.


Assuntos
Antifibrinolíticos/administração & dosagem , Perda Sanguínea Cirúrgica/prevenção & controle , Transfusão de Sangue/estatística & dados numéricos , Fraturas do Quadril/cirurgia , Tromboembolia/epidemiologia , Ácido Tranexâmico/administração & dosagem , Idoso , Idoso de 80 Anos ou mais , Dinamarca/epidemiologia , Feminino , Fixação de Fratura/métodos , Hemoglobinas/análise , Fraturas do Quadril/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sistema de Registros , Tromboembolia/mortalidade
2.
Bone Joint J ; 103-B(2): 264-270, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33517718

RESUMO

AIMS: Few studies have investigated potential consequences of strained surgical resources. The aim of this cohort study was to assess whether a high proportion of concurrent acute surgical admissions, tying up hospital surgical capacity, may lead to delayed surgery and affect mortality for hip fracture patients. METHODS: This study investigated time to surgery and 60-day post-admission death of patients 70 years and older admitted for acute hip fracture surgery in Norway between 2008 and 2016. The proportion of hospital capacity being occupied by newly admitted surgical patients was used as the exposure. Hip fracture patients admitted during periods of high proportion of recent admissions were compared with hip fracture patients admitted at the same hospital during the same month, on similar weekdays, and times of the day with fewer admissions. RESULTS: Among 60,072 patients, mean age was 84.6 years (SD 6.8), 78% were females, and median time to surgery was 20 hours (IQR 11 to 29). Overall, 14% (8,464) were dead 60 days after admission. A high (75th percentile) proportion of recent surgical admission compared to a low (25th percentile) proportion resulted in 20% longer time to surgery (95% confidence interval (CI) 16 to 25) and 20% higher 60-day mortality (hazard ratio 1.2, 95% CI 1.1 to 1.4). CONCLUSION: A high volume of recently admitted acute surgical patients, indicating probable competition for surgical resources, was associated with delayed surgery and increased 60-day mortality. Cite this article: Bone Joint J 2021;103-B(2):264-270.


Assuntos
Fixação de Fratura/estatística & dados numéricos , Recursos em Saúde/provisão & distribução , Fraturas do Quadril/cirurgia , Hospitalização/estatística & dados numéricos , Tempo para o Tratamento/estatística & dados numéricos , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Fraturas do Quadril/mortalidade , Humanos , Masculino , Noruega/epidemiologia , Resultado do Tratamento
3.
Bone Joint J ; 103-B(2): 271-278, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33517719

RESUMO

AIMS: Echocardiography is commonly used in hip fracture patients to evaluate perioperative cardiac risk. However, echocardiography that delays surgical repair may be harmful. The objective of this study was to compare surgical wait times, mortality, length of stay (LOS), and healthcare costs for similar hip fracture patients evaluated with and without preoperative echocardiograms. METHODS: A population-based, matched cohort study of all hip fracture patients (aged over 45 years) in Ontario, Canada between 2009 and 2014 was conducted. The primary exposure was preoperative echocardiography (occurring between hospital admission and surgery). Mortality rates, surgical wait times, postoperative LOS, and medical costs (expressed as 2013$ CAN) up to one year postoperatively were assessed after propensity-score matching. RESULTS: A total of 2,354 of 42,230 (5.6%) eligible hip fracture patients received a preoperative echocardiogram during the study period. Echocardiography ordering practices varied among hospitals, ranging from 0% to 23.0% of hip fracture patients at different hospital sites. After successfully matching 2,298 (97.6%) patients, echocardiography was associated with significantly increased risks of mortality at 90 days (20.1% vs 16.8%; p = 0.004) and one year (32.9% vs 27.8%; p < 0.001), but not at 30 days (11.4% vs 9.8%; p = 0.084). Patients with echocardiography also had a mean increased delay from presentation to surgery (68.80 hours (SD 44.23) vs 39.69 hours (SD 27.09); p < 0.001), total LOS (19.49 days (SD 25.39) vs 15.94 days (SD 22.48); p < 0.001), and total healthcare costs at one year ($51,714.69 (SD 54,675.28) vs $41,861.47 (SD 50,854.12); p < 0.001). CONCLUSION: Preoperative echocardiography for hip fracture patients is associated with increased postoperative mortality at 90 days and one year but not at 30 days. Preoperative echocardiography is also associated with increased surgical delay, postoperative LOS, and total healthcare costs at one year. Echocardiography should be considered an urgent test when ordered to prevent additional surgical delay. Cite this article: Bone Joint J 2021;103-B(2):271-278.


Assuntos
Ecocardiografia , Fixação de Fratura , Cardiopatias/diagnóstico por imagem , Fraturas do Quadril/cirurgia , Cuidados Pré-Operatórios/métodos , Idoso , Idoso de 80 Anos ou mais , Bases de Dados Factuais , Ecocardiografia/economia , Feminino , Seguimentos , Fixação de Fratura/economia , Cardiopatias/complicações , Fraturas do Quadril/complicações , Fraturas do Quadril/economia , Fraturas do Quadril/mortalidade , Custos Hospitalares/estatística & dados numéricos , Humanos , Tempo de Internação/economia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Ontário , Cuidados Pré-Operatórios/economia , Pontuação de Propensão , Medição de Risco , Tempo para o Tratamento
4.
Bone Joint J ; 103-B(2): 222-233, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33517730

RESUMO

AIMS: Current guidelines recommend surgery within 48 hours among patients presenting with hip fractures; however, optimal surgical timing for patients on oral anticoagulants (OACs) remains unclear. Individual studies are limited by small sample sizes and heterogeneous outcomes. The aim of this study was to conduct a systematic review and meta-analysis to summarize the effect of pre-injury OACs on time-to-surgery (TTS) and all-cause mortality among older adults with hip fracture treated surgically. METHODS: We searched MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) from inception to 14 October 2019 to identify studies directly comparing outcomes among hip fracture patients receiving direct oral anticoagulants (DOACs) or vitamin K antagonists (VKAs) prior to hospital admission to hip fracture patients not on OACs. Random effects meta-analyses were used to pool all outcomes (TTS, in-hospital mortality, and 30-day mortality). RESULTS: A total of 34 studies (involving 39,446 patients) were included in our systematic review. TTS was 13.7 hours longer (95% confidence interval (CI) 9.8 to 17.5; p < 0.001) among hip fracture patients on OACs compared to those not on OACs. This translated to a three-fold higher odds of having surgery beyond the recommended 48 hours from admission (odds ratio (OR) 3.0 (95% CI 2.1 to 4.3); p = 0.001). In-hospital mortality was higher (OR 1.4 (95% CI 1.0 to 1.8); p < 0.03) among anticoagulated patients. Among studies comparing anticoagulants, there was no statistically significant difference in time-to-surgery between patients taking a DOAC compared to a VKA. CONCLUSION: Patients presenting with a hip fracture who were taking OACs prior to injury experience a delay in time-to-surgery and higher mortality than non-anticoagulated patients. Patients on DOACs may be at risk of further delays. Evaluating expedited surgical protocols in hip fracture patients on OACs is an urgent priority, with the potential to decrease morbidity and mortality in this group of high-risk patients. Cite this article: Bone Joint J 2021;103-B(2):222-233.


Assuntos
Anticoagulantes/uso terapêutico , Fixação de Fratura , Fraturas do Quadril/cirurgia , Tromboembolia/tratamento farmacológico , Tromboembolia/prevenção & controle , Tempo para o Tratamento , Administração Oral , Fraturas do Quadril/complicações , Fraturas do Quadril/mortalidade , Humanos , Tromboembolia/complicações , Resultado do Tratamento
5.
Bone Joint J ; 103-B(4): 782-787, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33507811

RESUMO

AIMS: Despite the COVID-19 pandemic, incidence of hip fracture has not changed. Evidence has shown increased mortality rates associated with COVID-19 infection. However, little is known about the outcomes of COVID-19 negative patients in a pandemic environment. In addition, the impact of vitamin D levels on mortality in COVID-19 hip fracture patients has yet to be determined. METHODS: This multicentre observational study included 1,633 patients who sustained a hip fracture across nine hospital trusts in North West England. Data were collected for three months from March 2020 and for the same period in 2019. Patients were matched by Nottingham Hip Fracture Score (NHFS), hospital, and fracture type. We looked at the mortality outcomes of COVID-19 positive and COVID-19 negative patients sustaining a hip fracture. We also looked to see if vitamin D levels had an impact on mortality. RESULTS: The demographics of the 2019 and 2020 groups were similar, with a slight increase in proportion of male patients in the 2020 group. The 30-day mortality was 35.6% in COVID-19 positive patients and 7.8% in the COVID-19 negative patients. There was a potential association of decreasing vitamin D levels and increasing mortality rates for COVID-19 positive patients although our findings did not reach statistical significance. CONCLUSION: In 2020 there was a significant increase in 30-day mortality rates of patients who were COVID-19 positive but not of patients who were COVID-19 negative. Low levels of vitamin D may be associated with high mortality rates in COVID-19 positive patients. Cite this article: Bone Joint J 2021;103-B(4):782-787.


Assuntos
/complicações , Fraturas do Quadril/etiologia , Fraturas do Quadril/mortalidade , Deficiência de Vitamina D/complicações , Idoso , Idoso de 80 Anos ou mais , /epidemiologia , Auditoria Clínica , Feminino , Fraturas do Quadril/diagnóstico , Humanos , Masculino , Análise por Pareamento , Pessoa de Meia-Idade , Pandemias , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Reino Unido/epidemiologia , Deficiência de Vitamina D/diagnóstico , Deficiência de Vitamina D/epidemiologia
6.
Rev Esp Anestesiol Reanim ; 68(2): 65-72, 2021 02.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33461768

RESUMO

COVID-19 became a threat to the public health system, compromising the health of the population. Patients with hip fractures, due to their age and comorbidity, were high-risk patients in this pandemic. The purpose of this study was to observe how the pandemic affected the management of hip fractures in elderly patients. METHODS: This is a descriptive, retrospective study of all patients over the age of 65 diagnosed with a hip fracture that came to the emergency room of Vall d'Hebron University Hospital in the COVID-19 pandemic period, from the 11th of March to the 24th of April 2020. They were followed up during their hospital stay and 30 days after the fracture. RESULTS: A total of 63 patients were included, 18 (28.6%) of whom had a positive RT-qPCR for COVID-19. Four could not be operated on due to the severity of the disease they presented with upon admission, dying a few days afterwards. Three of these patients had COVID-19. The 83.3% of the patients with positive RT-qPCR presented respiratory symptoms during their hospitalization. The length of hospital stays of patients with a positive RT-qPCR (18.25±8.99 days) was longer than that of patients that were RT-qPCR negative (10.9±4.52 days) (P=.01). In-hospital mortality in operated patients was 20% in patients with a positive RT-qPCR, compared with 2.3% in the group of patients who tested negative (P=.018). Mortality at 30 days was 40% in the group with positive RT-qPCR vs 6.8% in patients not infected by SARS-CoV-2 (P=.002). CONCLUSION: SARS-CoV-2 infection in elderly patients with hip fractures increases both the length of hospital stay, as well as in-hospital and 30-day mortality.


Assuntos
/mortalidade , Fraturas do Quadril/mortalidade , Mortalidade Hospitalar , Pandemias , Idoso , Idoso de 80 Anos ou mais , /estatística & dados numéricos , Feminino , Fraturas do Quadril/cirurgia , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Prevalência , Estudos Retrospectivos , Fatores Sexuais , Espanha/epidemiologia
7.
Bone Joint J ; 103-B(1): 170-177, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33380201

RESUMO

AIMS: Infection after surgery increases treatment costs and is associated with increased mortality. Hip fracture patients have historically had high rates of methicillin-resistant Staphylococcus aureus (MRSA) colonization and surgical site infection (SSI). This paper reports the impact of routine MRSA screening and the "cleanyourhands" campaign on rates of MRSA SSI and patient outcome. METHODS: A total of 13,503 patients who presented with a hip fracture over 17 years formed the study population. Multivariable logistic regression was performed to determine risk factors for MRSA and SSI. Autoregressive integrated moving average (ARIMA) modelling adjusted for temporal trends in rates of MRSA. Kaplan-Meier estimators were generated to assess for changes in mortality. RESULTS: In all, 6,189 patients were identified before the introduction of screening and 7,314 in the post-screening cohort. MRSA infection fell from 69 cases to 15 in the post-screening cohort (p < 0.001). The ARIMA confirmed a significant reduction in MRSA SSI post-screening (p = 0.043) but no significant impact after hand hygiene alone (p = 0.121). Overall SSI fell (2.4% to 1.5%), however deep infection increased slightly (0.89% to 1.06%). ARIMA showed neither intervention affected overall SSI ("cleanyourhands" -0.172% (95% confidence interval (CI) -0.39% to 0.21); p = 0.122, screening -0.113% per year, (95% CI -0.34 to 0.12); p = 0.373). One-year mortality after deep SSI was unchanged after screening (50% vs 45%; p = 0.415). Only warfarinization (OR 3.616 (95% CI 1.366 to 9.569); p = 0.010) and screening (OR 0.189 (95% CI 0.086 to 0.414); p < 0.001) were significant covariables for developing MRSA SSI. CONCLUSION: While screening and decolonization may reduce MRSA-associated SSI, the benefit to patient outcome remains unclear. Overall deep SSI remains an unsolved problem that has seen little improvement over time. Preventing other hospital-associated infections should not be forgotten in the fight against MRSA. Cite this article: Bone Joint J 2021;103-B(1):170-177.


Assuntos
Infecção Hospitalar/microbiologia , Fraturas do Quadril/cirurgia , Staphylococcus aureus Resistente à Meticilina , Infecções Estafilocócicas/microbiologia , Infecção da Ferida Cirúrgica/microbiologia , Idoso , Idoso de 80 Anos ou mais , Infecção Hospitalar/mortalidade , Infecção Hospitalar/prevenção & controle , Feminino , Higiene das Mãos , Fraturas do Quadril/mortalidade , Humanos , Masculino , Fatores de Risco , Infecções Estafilocócicas/mortalidade , Infecções Estafilocócicas/prevenção & controle , Infecção da Ferida Cirúrgica/mortalidade , Infecção da Ferida Cirúrgica/prevenção & controle
8.
Rev. esp. anestesiol. reanim ; 68: 0-0, 2021. tab
Artigo em Espanhol | IBECS | ID: ibc-196757

RESUMO

La COVID-19 se convirtió en una amenaza para el sistema de salud público, comprometiendo la salud de la población. Los pacientes con fractura de cadera, debido a su edad y comorbilidad, fueron pacientes de alto riesgo en esta pandemia. La finalidad de este estudio fue observar cómo afectó la pandemia al manejo de las fracturas de cadera del paciente anciano. MÉTODOS: Se trata de un estudio descriptivo, retrospectivo de todos los pacientes mayores de 65 años diagnosticados de fractura de cadera que acudieron a urgencias del Hospital Universitario Vall d'Hebron en el periodo de pandemia COVID-19 comprendido entre el 11 de marzo y el 24 de abril de 2020. Fueron seguidos durante su ingreso hospitalario y a los 30 días de la fractura. RESULTADOS: Se incluyeron un total de 63 pacientes, 18 (28,6%) de los cuales tenían una RT-qPCR positiva para COVID-19. Cuatro no pudieron ser operados debido a la gravedad que presentaban al ingreso, falleciendo a los pocos días. Tres de estos pacientes tenían la COVID-19. El 83,3% de los pacientes con RT-qPCR positiva presentaron clínica respiratoria durante su hospitalización. La duración de la estancia hospitalaria de los pacientes con RT-qPCR positiva (18,25±8,99 días) fue mayor que los pacientes no COVID (10,9±4,52 días) (p = 0,01). La mortalidad intrahospitalaria de los pacientes intervenidos fue del 20% en los pacientes con RT-qPCR positiva en comparación con el 2,3% del grupo de pacientes que testaron negativo (p = 0,018). La mortalidad a los 30 días fue del 40% en el grupo con RT-qPCR positiva vs. el 6,8% de los pacientes no infectados por SARS-CoV-2 (p = 0,002). CONCLUSIÓN: La infección por SARS-CoV-2 en pacientes ancianos con fractura de cadera aumenta tanto el tiempo de ingreso hospitalario como la mortalidad intrahospitalaria y a los 30 días


COVID-19 became a threat to the public health system, compromising the health of the population. Patients with hip fractures, due to their age and comorbidity, were high-risk patients in this pandemic. The purpose of this study was to observe how the pandemic affected the management of hip fractures in elderly patients. METHODS: This is a descriptive, retrospective study of all patients over the age of 65 diagnosed with a hip fracture that came to the emergency room of Vall d'Hebron University Hospital in the COVID-19 pandemic period, from the 11th of March to the 24th of April 2020. They were followed up during their hospital stay and 30 days after the fracture. RESULTS: A total of 63 patients were included, 18 (28.6%) of whom had a positive RT-qPCR for COVID-19. Four could not be operated on due to the severity of the disease they presented with upon admission, dying a few days afterwards. Three of these patients had COVID-19. The 83.3% of the patients with positive RT-qPCR presented respiratory symptoms during their hospitalization. The length of hospital stays of patients with a positive RT-qPCR (18.25±8.99 days) was longer than that of patients that were RT-qPCR negative (10.9±4.52 days) (P=.01). In-hospital mortality in operated patients was 20% in patients with a positive RT-qPCR, compared with 2.3% in the group of patients who tested negative (P=.018). Mortality at 30 days was 40% in the group with positive RT-qPCR vs 6.8% in patients not infected by SARS-CoV-2 (P=.002). CONCLUSION: SARS-CoV-2 infection in elderly patients with hip fractures increases both the length of hospital stay, as well as in-hospital and 30-day mortality


Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Infecções por Coronavirus/mortalidade , Pneumonia Viral/mortalidade , Pandemias , Fraturas do Quadril/mortalidade , Tempo de Internação , Estudos Retrospectivos
9.
Maturitas ; 141: 20-25, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33036698

RESUMO

OBJECTIVES: Muscle strength is a possible predictor of adverse events. It could have prognostic value in patients with hip fracture (HF). The aim of this study was to determine if handgrip strength is associated with functional impairment, readmissions, and mortality at one year in elderly patients with HF. DESIGN: A prospective observational study was carried out. It included a cohort of patients aged 65 years or older with a diagnosis of fragility HF, consecutively from January 2013 to February 2014 and seen in follow-up at one year. Statistical analysis was performed using SPSS v21 software. MAIN OUTCOME MEASURES: Five hundred and nine patients with a mean age of 85.4 ± 0.3 years were included, of whom 403 (79.2 %) were women. Clinical and functional outcomes, laboratory parameters and anthropometric measurements were collected. RESULTS: Of the total sample, 339 (66.6 %) had reduced handgrip strength, and these patients were older, more frequently institutionalized, had poorer functional and cognitive status, higher comorbidity, higher surgical risk, lower body mass index and a greater intra-hospital mortality (all p < 0.01). At one year, patients with lower handgrip strength had a major change in their ability to walk (32.7 % vs. 10.9 %, p < 0.001) and a higher mortality rate (30.4 % vs. 8.8 %, p < 0.001). However, in patients over 91 years of age, there was no association between lower handgrip strength and change in ability to walk. There were no differences in the number of readmissions. CONCLUSION: Low handgrip strength in elderly patients with HF predicts greater functional disability and higher long-term mortality.


Assuntos
Força da Mão , Fraturas do Quadril/reabilitação , Hospitalização/estatística & dados numéricos , Recuperação de Função Fisiológica , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Estudos de Coortes , Feminino , Fraturas do Quadril/mortalidade , Humanos , Masculino , Limitação da Mobilidade , Prognóstico , Estudos Prospectivos , Espanha/epidemiologia , Caminhada
10.
Arch Osteoporos ; 15(1): 165, 2020 10 20.
Artigo em Inglês | MEDLINE | ID: mdl-33079274

RESUMO

In this study, the risk of fatality after hip fracture but not the risk of subsequent hip fractures was higher among men. INTRODUCTION: The purpose of this study was to analyze the risk factors for subsequent hip fractures and fatality after an initial hip fracture among Koreans older than 50 years of age using information in the national claims database. METHODS: Our study was conducted using data from the Korean National Health Insurance Service database from 2007 to 2016. A total of 16,915 Korean patients aged ≥ 50 years with a first hip fracture in 2012 were followed for 4 years. Data on fracture, comorbidity, and prescription variables were retrieved from the national registry. The Cox proportional hazards model was used to identify the risk factors affecting subsequent hip fractures and fatality after the initial hip fracture. RESULTS: A total of 952 patients had subsequent hip fractures, and 6793 patients died. The cumulative incidence rates were 1.3% after 1 year and 5.6% after 4 years. Old age, renal disease, dementia, and Parkinson's disease were associated with a higher risk of subsequent hip fractures. The fatality rate after the initial hip fracture was 1.6 times higher among men than among women. Certain risk factors for fatality, such as pneumonia after fracture, cerebrovascular disease, mild liver disease, renal disease, and malignancy, were more prevalent among men. CONCLUSION: During the study period, the risk of fatality after hip fracture but not the risk of subsequent hip fractures was higher among men. The gender difference in fatality might be explained by the larger burden of comorbid diseases among men.


Assuntos
Demência/complicações , Fraturas do Quadril/mortalidade , Nefropatias/complicações , Doença de Parkinson/complicações , Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , Causas de Morte , Comorbidade , Feminino , Fraturas do Quadril/etnologia , Fraturas do Quadril/etiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Pneumonia , Vigilância da População , República da Coreia/epidemiologia , Fatores de Risco , Distribuição por Sexo , Fatores Sexuais
11.
Rev. esp. cir. ortop. traumatol. (Ed. impr.) ; 64(5): 342-349, sept.-oct. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-197613

RESUMO

INTRODUCCIÓN: La fractura de cadera es una patología traumática muy frecuente en el anciano con alta mortalidad. Diferentes factores se han asociado con la mortalidad tras la cirugía (edad comorbilidades). Hay factores quirúrgicos que se asocian con la mortalidad, pero no se han relacionado con los diferentes índices de mortalidad y comorbilidades médicas. OBJETIVO: Analizar los parámetros quirúrgicos con influencia en la mortalidad en la cirugía de las fracturas extracapsulares de cadera en el paciente anciano, así como la influencia de las comorbilidades médicas de estos pacientes en la mortalidad, mediante el índice de comorbilidad de Charlson abreviado (CCI). MATERIAL Y MÉTODO: Revisión retrospectiva de 187 pacientes intervenidos en 2015. Se recogieron datos sobre la edad y sexo, lateralidad y tipo de fractura; demora quirúrgica, tiempo quirúrgico, tipo de material de osteosíntesis, estancia media. La presencia de comorbilidades se determinó empleando el CCI. RESULTADOS: La edad media fue de 85 años. Con respecto al índice de comorbilidad de Charlson abreviado, 67,4% de los pacientes tenían una puntuación entre 0 y 1, el 23,5% de 2, y un 9,1% > 2. La mortalidad al mes y al año tras la cirugía fue de 5,3% y 14,4%, respectivamente. Se registraron 43 complicaciones, de las cuales 31 fueron complicaciones médicas. De los 27 pacientes fallecidos en el primer año, 14 (51,8%) sufrieron complicaciones, 48,2% de las mismas fueron complicaciones médicas. DISCUSIÓN: El análisis multivariante mostró diferencias significativas con respecto a edad, complicaciones médicas e índice de Charlson abreviado de dos con respecto a la mortalidad. No existe asociación entre demora y tiempo quirúrgico con el aumento de la mortalidad. CONCLUSIONES: No se demostró asociación de los parámetros quirúrgicos estudiados (demora y tiempo quirúrgico, patrón y estabilidad de la fractura, criterios de reducción, complicaciones quirúrgicas) con aumento de mortalidad a corto y largo plazo. Los pacientes con mayor edad, comorbilidades medidas con CCI abreviado y los que sufren complicaciones médicas presentan mayor riesgo de mortalidad al mes y al año de la cirugía


INTRODUCTION: Hip fracture is a very frequent traumatic pathology in the elderly with high mortality. Different factors have been associated with mortality after surgery (age comorbidities). There are surgical factors that are associated with mortality, but they have not been related to the different mortality rates and medical comorbidities. OBJECTIVE: To analyze the surgical parameters with influence on mortality in surgery of extracapsular hip fractures in the elderly patient, as well as the influence of medical comorbidities of these patients on mortality, by means of the Charlson comorbidity index (CCI). METHOD: Retrospective review of 187 patients operated on in 2015. Data were collected on age and sex, laterality and type of fracture; surgical delay, surgical time, type of osteosynthesis material, mean stay. The presence of comorbidities was determined using the JRC. RESULTS: Mean age was 85 years. Regarding the Charlson comorbidity index in brief, 67.4% of patients had a score between 0 and 1, 23.5% of 2, and 9.1% >2. Mortality at one month and one year after surgery was 5.3% and 14.4% respectively. Forty-three complications were recorded, of which 31 were medical complications. Of the 27 patients who died in the first year, 14 (51.8%) suffered complications, 48.2% of which were medical complications. DISCUSSION: Multivariate analysis showed significant differences with respect to age, medical complications and Charlson index abbreviated to 2 with respect to mortality. There is no association between delay and surgical time with increased mortality. CONCLUSIONS: No association was demonstrated between the surgical parameters studied (surgical delay and time, fracture pattern and stability, reduction criteria, surgical complications) and increased short and long-term mortality. Patients with older age, comorbidities measured with abbreviated CCI and those suffering medical complications have a higher risk of mortality at the month and year of surgery


Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Fraturas do Quadril/cirurgia , Causas de Morte , Evolução Fatal , Indicadores de Morbimortalidade , Fixação Interna de Fraturas/mortalidade , Fraturas do Quadril/mortalidade , Complicações Pós-Operatórias/epidemiologia , Fatores de Risco , Estudos Retrospectivos
12.
Bone Joint J ; 102-B(10): 1384-1391, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32993327

RESUMO

AIMS: Hospital case volume is shown to be associated with postoperative outcomes in various types of surgery. However, conflicting results of volume-outcome relationship have been reported in hip fracture surgery. This retrospective cohort study aimed to evaluate the association between hospital case volume and postoperative outcomes in patients who had hip fracture surgery. We hypothesized that higher case volume would be associated with lower risk of in-hospital and one-year mortality after hip fracture surgery. METHODS: Data for all patients who underwent surgery for hip fracture from January 2008 to December 2016 were extracted from the Korean National Healthcare Insurance Service database. According to mean annual case volume of surgery for hip fracture, hospitals were classified into very low (< 30 cases/year), low (30 to 50 cases/year), intermediate (50 to 100 cases/year), high (100 to 150 cases/year), or very high (> 150 cases/year) groups. The association between hospital case volume and in-hospital mortality or one-year mortality was assessed using the logistic regression model to adjust for age, sex, type of fracture, type of anaesthesia, transfusion, comorbidities, and year of surgery. RESULTS: Between January 2008 and December 2016, 269,535 patients underwent hip fracture surgery in 1,567 hospitals in Korea. Compared to hospitals with very high volume, in-hospital mortality rates were significantly higher in those with high volume (odds ratio (OR) 1.10, 95% confidence interval ((CI) 1.02 to 1.17, p = 0.011), low volume (OR 1.22, 95% CI 1.14 to 1.32, p < 0.001), and very low volume (OR 1.25, 95% CI 1.16 to 1.34, p < 0.001). Similarly, hospitals with lower case volume showed higher one-year mortality rates compared to hospitals with very high case volume (low volume group, OR 1.15, 95% CI 1.11 to 1.19, p < 0.001; very low volume group, OR 1.10, 95% CI 1.07 to 1.14, p < 0.001). CONCLUSION: Higher hospital case volume of hip fracture surgery was associated with lower in-hospital mortality and one-year mortality in a dose-response fashion. Cite this article: Bone Joint J 2020;102-B(10):1384-1391.


Assuntos
Fraturas do Quadril/mortalidade , Fraturas do Quadril/cirurgia , Mortalidade Hospitalar , Hospitais com Alto Volume de Atendimentos/estatística & dados numéricos , Hospitais com Baixo Volume de Atendimentos/estatística & dados numéricos , Complicações Pós-Operatórias/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , República da Coreia , Estudos Retrospectivos
13.
Medicine (Baltimore) ; 99(37): e21862, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32925723

RESUMO

This study aimed to compare the early outcome of proximal femoral nail antirotation (PFNA) and bipolar hemiarthroplasty (BPH) in elderly intertrochanteric fractures (ITFs) patients aged 85 years or more.This is a prospective cohort study, and we analyzed 120 elderly patients aged 85 years or more presented with ITFs who underwent BPH and PFNA between January 2017 and July 2018. 84 patients treated with PFNA were set as Group A, and 36 patients treated with BPH were set as Group B. Data such as gender, age, period of follow-up, fracture classification (according to Evans-Jensen classification), preoperative ASA (American Society of Anesthesiologists) physical status, interval between injury and operation, method of anaesthesia, duration of operation time, blood loss during surgery, time of weight bearing after operation, incidence of complications 2 weeks after operation, mortality rates and Harris Hip Score 12 months after operation were recorded and compared.There are no statistically significant differences when compared general data in patients from group A and B (P > .05). Operation time in Group A is less than Group B (103.33, 40-230 min vs 122.64, 75-180 minute, P < .01). Blood loss during surgery in Group A is less than Group B (70.24, 50-100 mL vs 194.44, 100-500 mL, P < .01). Time of weight bearing after operation in Group A is longer than Group B (50.70, 7-100 days vs 6.67, 4-14 days, P < .01). Incidence of complications 2 weeks after operation in Group A is less than Group B (14.12% vs 36.11%, P < .01). Mortality rates 12 months after operation in Group A is similar with Group B (13.10% vs 19.44%, P > .05). Harris Hip Score 12 months after operation in Group A is similar with Group B (64.64,0-91 points vs 64.41, 0-90 points, P > .05).Although BPH and PFNA have similar functional outcome and mortality rates 12 months after operation, BPH has more postoperative complications in elderly patients aged 85 years or more with ITFs, Bipolar Hemiarthroplasty should not be selected as the primary option for ITFs in elderly patients aged 85 years or more.


Assuntos
Fixação Intramedular de Fraturas/mortalidade , Hemiartroplastia/mortalidade , Fraturas do Quadril/cirurgia , Complicações Pós-Operatórias/mortalidade , Idoso de 80 Anos ou mais , Pinos Ortopédicos , Feminino , Fixação Intramedular de Fraturas/métodos , Avaliação Geriátrica , Hemiartroplastia/métodos , Fraturas do Quadril/mortalidade , Humanos , Masculino , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Resultado do Tratamento
14.
PLoS One ; 15(9): e0238248, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32877436

RESUMO

There is no clear evidence how effective the antiresorptive (AR) drugs alendronate and raloxifene are at reducing risk of second hip fracture and mortality in dialysis populations. The purpose of this study was to compare the risk of hospitalization for second hip fracture and risk of mortality between AR user and non-user groups in Taiwanese women on long-term dialysis with hip fractures. We conducted a retrospective cohort study using Taiwan National Health Insurance Research Datasets. Long-term dialysis women older than 50 years with newly diagnosed hip fractures and new to AR therapy from 2005 to 2011 were recruited. The patients were divided into AR users and non-users and matched by propensity score. We used Cox Proportional Hazards models to assess association of AR with risks of second hip fracture and mortality. Totally, 1,079 dialysis patients were included, and after matching, we were left with 74 AR users and 74 non-users. AR users did not show a significant reduction in the incidence of second hip fracture compared with non-users (adjusted Hazard Ratio (HR): 0.91, 95% CI: 0.30-2.76), and alendronate users exhibited higher risk of second hip fracture compared with raloxifene users (adjusted HR: 2.80, 95% CI: 0.42-18.79). In addition, AR users were found to have significantly lower 1- and 2-year mortality rates than the non-users (1- year: adjusted HR 0.25, 95% CI, 0.07-0.90; 2-year: 0.35, 95%CI: 0.17-0.72). AR treatment did not significantly improve the risk of second hip fracture but significantly reduce mortality in older women on dialysis. Further clinical trials on effectiveness of AR medications for dialysis populations should be warranted.


Assuntos
Alendronato/administração & dosagem , Conservadores da Densidade Óssea/administração & dosagem , Fraturas do Quadril/mortalidade , Cloridrato de Raloxifeno/administração & dosagem , Diálise Renal/mortalidade , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Fraturas do Quadril/epidemiologia , Fraturas do Quadril/terapia , Humanos , Incidência , Estudos Longitudinais , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida , Taiwan/epidemiologia
15.
Medicine (Baltimore) ; 99(33): e21676, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32872035

RESUMO

Hip fractures in older patients requiring dialysis are associated with high mortality. The primary aim of this study was to evaluate the specific burden of dialysis on 30-day mortality following hip fracture surgery. The secondary aim was to determine the burden of dialysis on overall survival as well as several postoperative complications.A retrospective cohort study was conducted using data from the Korean National Health Insurance Research Database. Patients were aged ≥65 years and underwent hip fracture surgery during the period from 2009 to 2015. To construct a matched cohort, each dialysis patient was matched to 4 non-dialysis patients based on age, sex, hospital type, anesthesia type, and comorbidities. Survival status was determined 30 days after surgery and at the end of the study period.In total, 96,289 patients were identified. Among them, 1614 dialysis patients were included and matched to 6198 non-dialysis patients. During the 30-day postoperative period, there were 102 mortality events in the dialysis group and 127 in the non-dialysis group, for an adjusted hazard ratio of 3.12 (95% confidence interval, 2.42-4.09). Overall, by the end of the study period, there were 1120 mortality events in the dialysis group and 2731 in the non-dialysis group, for an adjusted hazard ratio of 1.97 (95% confidence interval, 1.83-2.1). These findings may be limited by the characteristics of the administrative database.The 30-day mortality rate was 3-fold higher in the dialysis group than in the non-dialysis group, while the overall mortality rate was approximately 2-fold higher in the dialysis group than in the non-dialysis group. These findings suggest that caution in the perioperative period is required in dialysis patients undergoing hip fracture surgery. The results of our study represent only an association between dialysis and mortality. Further studies are necessary to investigate the possible causal effect of dialysis on mortality and complications after hip fracture surgery.


Assuntos
Fraturas do Quadril/mortalidade , Complicações Pós-Operatórias/epidemiologia , Diálise Renal/mortalidade , Idoso , Estudos de Casos e Controles , Bases de Dados Factuais , Feminino , Fraturas do Quadril/cirurgia , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco
16.
J Orthop Trauma ; 34(9): e317-e324, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32815845

RESUMO

OBJECTIVES: (1) To demonstrate how a risk assessment tool modified to account for the COVID-19 virus during the current global pandemic is able to provide risk assessment for low-energy geriatric hip fracture patients. (2) To provide a treatment algorithm for care of COVID-19 positive/suspected hip fractures patients that accounts for their increased risk of morbidity and mortality. SETTING: One academic medical center including 4 Level 1 trauma centers, 1 university-based tertiary care referral hospital, and 1 orthopaedic specialty hospital. PATIENTS/PARTICIPANTS: One thousand two hundred seventy-eight patients treated for hip fractures between October 2014 and April 2020, including 136 patients treated during the COVID-19 pandemic between February 1, 2020 and April 15, 2020. INTERVENTION: The Score for Trauma Triage in the Geriatric and Middle-Aged ORIGINAL (STTGMAORIGINAL) score was modified by adding COVID-19 virus as a risk factor for mortality to create the STTGMACOVID score. Patients were stratified into quartiles to demonstrate differences in risk distribution between the scores. MAIN OUTCOME MEASUREMENTS: Inpatient and 30-day mortality, major, and minor complications. RESULTS: Both STTGMA score and COVID-19 positive/suspected status are independent predictors of inpatient mortality, confirming their use in risk assessment models for geriatric hip fracture patients. Compared with STTGMAORIGINAL, where COVID-19 patients are haphazardly distributed among the risk groups and COVID-19 inpatient and 30 days mortalities comprise 50% deaths in the minimal-risk and low-risk cohorts, the STTGMACOVID tool is able to triage 100% of COVID-19 patients and 100% of COVID-19 inpatient and 30 days mortalities into the highest risk quartile, where it was demonstrated that these patients have a 55% rate of pneumonia, a 35% rate of acute respiratory distress syndrome, a 22% rate of inpatient mortality, and a 35% rate of 30 days mortality. COVID-19 patients who are symptomatic on presentation to the emergency department and undergo surgical fixation have a 30% inpatient mortality rate compared with 12.5% for patients who are initially asymptomatic but later develop symptoms. CONCLUSION: The STTGMA tool can be modified for specific disease processes, in this case to account for the COVID-19 virus and provide a robust risk stratification tool that accounts for a heretofore unknown risk factor. COVID-19 positive/suspected status portends a poor outcome in this susceptible trauma population and should be included in risk assessment models. These patients should be considered a high risk for perioperative morbidity and mortality. Patients with COVID-19 symptoms on presentation should have surgery deferred until symptoms improve or resolve and should be reassessed for surgical treatment versus definitive nonoperative treatment with palliative care and/or hospice care. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of Levels of Evidence.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Fraturas do Quadril/complicações , Fraturas do Quadril/cirurgia , Pneumonia Viral/complicações , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Artroplastia de Quadril , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/mortalidade , Feminino , Fixação Interna de Fraturas , Avaliação Geriátrica , Fraturas do Quadril/mortalidade , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/mortalidade , Valor Preditivo dos Testes , Medição de Risco , Fatores de Risco , Taxa de Sobrevida , Triagem
17.
J Orthop Trauma ; 34(9): e325-e329, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32815846

RESUMO

OBJECTIVES: During the COVID-19 pandemic, the care of hip fracture patients remains a clinical priority. Our study aims to investigate the 30-day mortality rate of hip fracture patients during the first 30 days of the pandemic in the United Kingdom. METHODS: A single-center, observational, prospective study of patients presenting with hip fractures. Data collection started from "day 0" of the COVID-19 pandemic in the United Kingdom and continued for 30 days. We collected data on time to surgery, Clinical Frailty Scale score, Nottingham Hip Fracture Score, COVID-19 infection status, 30-day mortality, and cause of death. For comparison, we collected retrospective data during the same 30-day period in 2018, 2019, and the previous 6 months (Control groups A, B, and C, respectively). RESULTS: Forty-three patients were included in the study. There was no difference in age or gender between the Study and Control groups. The 30-day mortality rate of the Study group was 16.3%, which was higher than Control groups A (P = 0.022), B (P = 0.003) and C (P = 0.001). The prevalence of COVID-19 infection in our Study group was 26%. Of the 7 mortalities recorded, 4 patients tested positive for COVID-19 infection. In our Study group, COVID-19 infection correlated significantly with 30-day mortality (P = 0.002, odds ratio 2.4). CONCLUSIONS: Our study demonstrated a significant increase in 30-day mortality among hip fracture patients during the first 30 days of the COVID-19 pandemic in the United Kingdom. A positive COVID-19 test result in patients with hip fractures is associated with a 2.4-fold increase in risk of 30-day mortality. LEVEL OF EVIDENCE: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Fraturas do Quadril/mortalidade , Pneumonia Viral/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril , Infecções por Coronavirus/diagnóstico , Feminino , Fixação Interna de Fraturas , Fraturas do Quadril/complicações , Fraturas do Quadril/cirurgia , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico , Estudos Prospectivos , Fatores de Risco , Taxa de Sobrevida , Fatores de Tempo , Reino Unido
18.
J Bone Joint Surg Am ; 102(13): e69, 2020 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-32618917

RESUMO

BACKGROUND: The outbreak of coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), in December 2019 in Wuhan, People's Republic of China, has developed into an unprecedented pandemic with enormous pressure on health-care providers around the world. A higher mortality rate has been described in older infected individuals. Patients with hip fracture are a particularly vulnerable population during this pandemic because older age is associated with a higher mortality rate. Our aim was to describe the early mortality rate and demographic variables in a hip fracture sample population in Spain during the coronavirus pandemic. METHODS: This is a multicenter, observational, retrospective, descriptive study. We collected data from 13 major hospitals in Spain from the beginning of the national state of alarm (declared on March 14, 2020, by the Spanish government) until the end of our study period on April 4, 2020. All patients who were ≥65 years of age, presented to the Emergency Department of the participating hospitals during this period with a diagnosis of proximal femoral fracture, and had a minimum follow-up of 10 days were included in the cohort. In addition to mortality, demographic and other potential prognostic variables were also collected. RESULTS: In this study, 136 patients with a hip fracture were included. Of these patients, 124 underwent a surgical procedure and 12 were managed nonoperatively. The total mortality rate was 9.6%. Sixty-two patients were tested for COVID-19, with 23 patients being positive. The mortality rate for these 23 patients was 30.4% (7 of 23 patients) at a mean follow-up of 14 days. The mortality rate was 10.3% (4 of 39) for patients who had been tested and had a negative result and 2.7% (2 of 74) for patients who had not been tested. Of the 12 patients who were managed nonoperatively, 8 (67%) died, whereas, of the 124 patients who were surgically treated, 5 (4%) died. Results differed among centers. CONCLUSIONS: There is a higher mortality rate in patients with a hip fracture and an associated positive test for COVID-19. LEVEL OF EVIDENCE: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Infecções por Coronavirus/epidemiologia , Fraturas do Fêmur/mortalidade , Pandemias , Pneumonia Viral/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Feminino , Fraturas do Quadril/mortalidade , Humanos , Masculino , Estudos Retrospectivos , Espanha/epidemiologia
19.
J Stroke Cerebrovasc Dis ; 29(8): 104976, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32689623

RESUMO

BACKGROUND: Hip fractures are a significant post-stroke complication. We examined predictors of hip fracture risk after stroke using data from the Women's Health Initiative (WHI). In particular, we examined the association between post-stroke disability levels and hip fracture risk. METHODS: The WHI is a prospective study of 161,808 postmenopausal women aged 50-79 years. Trained physicians adjudicated stroke events and hip fractures. Our study included stroke survivors from the observational and clinical trial arms who had a Glasgow Outcome Scale of good recovery, moderately disabled, or severely disabled and survived more than 7 days post-stroke. Hip fracture-free status was compared across disability levels. Secondary analysis examined hip fracture risk while accounting for competing risk of death. RESULTS: Average age at time of stroke was 74.6±7.2 years; 84.3% were white. There were 124 hip fractures among 4,640 stroke survivors over a mean follow-up time of 3.1±1.8 years. Mortality rate was 23.3%. Severe disability at discharge (Hazard Ratio (HR): 2.1 (95% Confidence Interval (CI): 1.4-3.2), but not moderate disability (HR: 1.1 (95%CI: 0.7-1.7), was significantly associated with an increased risk of hip fracture compared to good recovery status. This association was attenuated after accounting for mortality. White race, increasing age and higher Fracture Risk Assessment Tool (FRAX)-predicted hip fracture risk (without bone density information) were associated with an increased hip fracture risk. After accounting for mortality, higher FRAX risk and white race remained significant. CONCLUSION: Severe disability after stroke and a higher FRAX risk score were associated with risk of subsequent hip fracture. After accounting for mortality, only the FRAX risk score remained significant. The FRAX risk score appears to identify stroke survivors at high risk of fractures. Our results suggest that stroke units can consider the incorporation of osteoporosis screening into care pathways.


Assuntos
Avaliação da Deficiência , Escala de Resultado de Glasgow , Fraturas do Quadril/epidemiologia , Osteoporose Pós-Menopausa/epidemiologia , Fraturas por Osteoporose/epidemiologia , Acidente Vascular Cerebral/diagnóstico , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Fraturas do Quadril/diagnóstico , Fraturas do Quadril/mortalidade , Humanos , Pessoa de Meia-Idade , Osteoporose Pós-Menopausa/diagnóstico , Osteoporose Pós-Menopausa/mortalidade , Fraturas por Osteoporose/diagnóstico , Fraturas por Osteoporose/mortalidade , Pós-Menopausa , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Fatores Sexuais , Acidente Vascular Cerebral/mortalidade , Acidente Vascular Cerebral/fisiopatologia , Fatores de Tempo , Estados Unidos/epidemiologia
20.
PLoS One ; 15(6): e0234041, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32492053

RESUMO

BACKGROUND: One-year mortality after hip-fracture is a widely used outcome measure when comparing hospital care performance. However, traditional analyses do not explicitly consider the referral of patients to municipality care after just a few days of hospitalization. Furthermore, traditional analyses investigates hospital (or municipality) variation in patient outcomes in isolation rather than as a component of the underlying patient variation. We therefore aimed to extend the traditional approach to simultaneously estimate both case-mix adjusted hospital and municipality comparisons in order to disentangle the amount of the total patient variation in clinical outcomes that was attributable to the hospital and municipality level, respectively. METHODS: We determined 1-year mortality risk in patients aged 65 or above with hip fractures registered in Sweden between 2011 and 2014. We performed cross-classified multilevel analysis with 54,999 patients nested within 54 hospitals and 290 municipalities. We adjusted for individual demographic, socioeconomic and clinical characteristics. To quantify the size of the hospital and municipality variation we calculated the variance partition coefficient (VPC) and the area under the receiver operator characteristic curve (AUC). RESULTS: The overall 1-year mortality rate was 25.1%. The case-mix adjusted rates varied from 21.7% to 26.5% for the 54 hospitals, and from 18.9% to 29.5% for the 290 municipalities. The VPC was just 0.2% for the hospital and just 0.1% for the municipality level. Patient sociodemographic and clinical characteristics were strong predictors of 1-year mortality (AUC = 0.716), but adding the hospital and municipality levels in the cross-classified model had a minor influence (AUC = 0.718). CONCLUSIONS: Overall in Sweden, one-year mortality after hip-fracture is rather high. However, only a minor part of the patient variation is explained by the hospital and municipality levels. Therefore, a possible intervention should be nation-wide rather than directed to specific hospitals or municipalities.


Assuntos
Fraturas do Quadril/mortalidade , Avaliação de Resultados em Cuidados de Saúde , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Cidades , Bases de Dados Factuais , Demografia , Feminino , Fraturas do Quadril/patologia , Hospitais , Humanos , Modelos Logísticos , Masculino , Análise Multinível , Curva ROC , Fatores de Risco , Suécia
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