Functionality, comorbidity, complication & surgery of hip fracture in older adults by age distribution

SUMMARY BACKGROUND Hip fractures may be the greatest complication secondary to osteoporotic disorder. The objective of this study was to determine the influence of age distribution in the functionality, comorbidity, complications and surgical features of older adults with hip fractures. METHODS A prospective cohort study was carried out from 2013 to 2014. A sample of 557 adults over 75 years old with osteoporotic hip fractures was recruited from the Orthogeriatric Unit of the León University Hospital (Spain). Age distributions of 75-84, 85-90 and >90 years old were considered. Firstly, sociodemographic data, fracture type and hospital staying days were collected. Secondly, baseline functionality (Barthel index), ambulation, cognitive impairment and comorbidities were described. Thirdly, surgical intervention, urgency, type, American Association of Anesthesiologists (ASA) scores, non-surgical cause, and baseline pharmacologic treatments were determined. Finally, complications and features at hospital discharge were observed. RESULTS The age ranges did not show any statistically-significant differences (P<.05; R2=.000-.005) for gender, fracture type, or number of hospital staying days. Statistically-significant differences (P<.05; R2=.011-.247) between age groups were observed for Barthel index, cognitive impairment, dementia, osteoporosis, Parkinson's disease, aortic stenosis, surgery type, ASA-score, non-surgical cause, benzodiazepines, antidementia, anti-osteoporosis, insulin, pharmacologic treatments, renal function alteration, heart failure, destination and ambulation features. All other measurements did not show statistically-significant differences (P>.05; R2=.000-.010). CONCLUSION Age distributions greater than 75 years old may determine the functionality, comorbidities, surgical features, baseline pharmacologic treatments, complications and features at hospital discharge for older adults who suffer a hip fracture.

RESUMO CONTEXTO As fraturas do quadril podem ser a maior complicação secundária à doença osteoporótica. O objetivo deste estudo foi determinar a influência da distribuição etária na funcionalidade, comorbidade, complicações e características cirúrgicas de idosos com fratura de quadril. MÉTODOS Um estudo prospectivo de coorte foi realizado de 2013-2014. Uma amostra de 557 adultos mais velhos, com mais de 75 anos, com fratura de quadril osteoporótica foi recrutada na Unidade Ortogeriátrica do Hospital Universitário de León (Espanha). As distribuições de idade de 75-84, 85-90 e >90 anos foram consideradas. Em primeiro lugar, foram coletados dados sociodemográficos, tipo de fratura e dias de permanência hospitalar. Em segundo lugar, foram descritas funcionalidades de base (índice Barthel), ambulação, comprometimento cognitivo e comorbidades. Em terceiro lugar, determinaram-se a intervenção cirúrgica, a urgência, o tipo, os resultados da Associação Americana de Anestesiologistas (ASA), a causa não cirúrgica e os tratamentos farmacológicos iniciais. Finalmente, foram observadas complicações e características na alta hospitalar. RESULTADOS As faixas etárias não mostraram diferenças estatisticamente significativas (P <,05; R2 = ,000-,005) para sexo, tipo de fratura ou dias de permanência hospitalar. Foram apresentadas diferenças estatisticamente significativas (P <,05; R2 = ,011-,247) para o índice de Barthel, comprometimento cognitivo, demência, osteoporose, doença de Parkinson, estenose aórtica, tipo de cirurgia, pontuação ASA, causa não cirúrgica, benzodiazepínicos, antidementia, antiosteoporose, insulina, tratamentos farmacológicos, alteração da função renal, insuficiência cardíaca, destino e características de ambulação entre grupos etários. O restante das medidas não apresentou diferença estatisticamente significativa (P> 0,05; R2 = ,000-,010). CONCLUSÃO As distribuições de idade após 75 anos podem determinar a funcionalidade, comorbidades, características cirúrgicas, tratamentos farmacológicos de base, complicações e características na alta hospitalar de adultos mais velhos que sofrem fratura de quadril.

Early interdisciplinary hospital intervention for elderly patients with hip fractures : functional outcome and mortality

OBJECTIVES: Hip fractures are associated with high levels of co-morbidity and mortality. Orthogeriatric units have been shown to be effective with respect to functional recovery and mortality reduction. The aim of this study is to document the natural history of early multidisciplinary intervention in elderly patients with hip fractures and to establish the prognostic factors of mortality and walking ability after discharge. METHODS: This observational, retrospective study was performed in an orthogeriatric care unit on patients aged >70 years with a diagnosis of hip fracture between 2004 and 2008. This study included 1363 patients with a mean age of 82.7 + 6.4 years. RESULTS: On admission to the unit, the average Barthel score of these patients was 77.2 + 27.8 points, and the average Charlson index score was 2.14 + 2.05. The mean length of stay was 8.9 + 4.26 days, and the readmission rate was 2.3%. The in-hospital mortality rate was 4.7%, and the mortality rates at one, six, and 12 months after discharge were 8.7%, 16.9%, and 25.9%, respectively. The Cox proportional hazards model estimated that male sex, Barthel scale, heart failure, and cognitive impairment were associated with an increased risk of death. With regard to functionality, 63.7% of the patients were able to walk at the time of discharge, whereas 77.4% and 80.1% were able to walk at one month and six months post-discharge, respectively. The factors associated with a worse functional recovery included cognitive impairment, performance status, age, stroke, Charlson score, and delirium during the hospital stay. CONCLUSIONS: Early multidisciplinary intervention appears to be effective for the management of hip fracture. Age, male sex, baseline function, cognitive impairment and previous comorbidities are associated with a higher mortality rate and worse functional recovery.

Morbilidad y mortalidad por fractura de cadera / Morbility and mortality due to hip fracture

Objetivo: demostrar las causas fundamentales que atentan contra la morbilidad y mortalidad de los pacientes operados de fractura de cadera. Métodos: se realizó un trabajo descriptivo, transversal y prospectivo de los pacientes operados de fractura de cadera en el Hospital General Dr. Ernesto Guevara de la Serna, en el período comprendido entre enero de 2007 y septiembre de 2009. Resultados: se demostró un predominio de esta lesión en el sexo femenino (60,7 por ciento) y en los pacientes entre los 71 y 80 años de edad (26,6 por ciento), igualmente la cirugía de urgencia fue la opción terapéutica más usada en 69,3 por ciento de los casos; las fracturas trocantéricas resultaron las más frecuentes. La descompensación de enfermedades de base y la decisión familiar, con 25,3 por ciento, 18,7 por ciento y 16 por ciento fueron las principales causas que obstaculizaron la cirugía de urgencia. En los pacientes con una estadía preoperatoria menor de 72 h, el porcentaje de complicaciones fue bajo. Conclusiones: la desorientación, la bronconeumonía y las escaras de decúbito, resultaron las complicaciones más frecuentes. El porcentaje de fallecidos fue mucho mayor en los pacientes con familias disfuncionales que en las familias funcionales, demostrándose el papel determinante del entorno familiar en la evolución y el pronóstico de estos pacientes

Objective: to demonstrate the main causes to attempt the morbility and mortality of patients operated on hip fracture. Methods: a prospective, cross-sectional and descriptive study was conducted in the patients operated on hip fracture in the Dr. Ernesto Guevara de la Serna General Teaching Hospital from January, 2007 to September, 2009. Results: there was predominance of this type of lesion in female sex (60.7 percent) and in patients aged between 71 and 80 (26.6 percent); the emergency surgery was the therapeutical option more used in the 69.3 percent of cases; the trochanteric fractures were the more frequent ones. The decompensation of base disease and the family decision with a 25.3 percent, 18.7 percent and 16 percent were the leading causes hampered the emergency surgery. In patients with a preoperative stage less than 72 h, the percentage of complications was low. Conclusions: the disorientation, bronchopneumonia and decubitus sores were the more frequent complications. The percentage of deceased was greater in patients with dysfunctional families than in the functional ones, demonstrating the determinant role of family environment in the natural history and prognosis of these patients