RESUMO
Chronic kidney disease (CKD) is a documented risk factor for hip fracture mortality. CKD represents a spectrum of disease and there is no clear evidence differentiating the risk between patients with early versus end-stage CKD. The purpose of this study was to explore the relationship between the stages of CKD and mortality following operative treatment of hip fractures. Four hundred ninety-eight patients were analyzed; 81 were identified as having CKD. This study followed overall patient mortality at 90 days and at 1 year postoperatively. Patients with CKD had higher mortality at both 90 days and 1 year compared with those without CKD (hazard ratio 1.69 and 1.84, respectively). In a subgroup analysis to determine the effect of CKD stage, only stage 3 CKD was associated with increased mortality. The orthopaedic surgeon can play a key role in identifying at-risk patients and help to facilitate additional management. (Journal of Surgical Orthopaedic Advances 27(3):226-230, 2018).
Assuntos
Fraturas do Quadril/mortalidade , Insuficiência Renal Crônica/epidemiologia , Idoso , Estudos de Casos e Controles , Comorbidade , Feminino , Fixação Interna de Fraturas , Fraturas do Quadril/cirurgia , Humanos , Masculino , Mortalidade , Análise Multivariada , Período Pós-Operatório , Modelos de Riscos Proporcionais , Insuficiência Renal Crônica/metabolismo , Estudos Retrospectivos , Índice de Gravidade de DoençaRESUMO
The purpose of this study was to identify the specific risk factors that affect mortality in patients with hip fractures and differentiate mortality-associated factors between intertrochanteric (IT) and femoral neck (FN) fractures. A total of 1538 consecutive patients with hip fractures were treated at the authors' institution between January 2005 and October 2013. Ultimately 858 IT and 479 FN fracture patients were included on the basis of age >60 years with an isolated hip fracture. Mortality rate at 90 days was 12.1% for IT and 9.6% for FN fractures. In both IT and FN fractures, variables associated with mortality risk include increased age, greater days to surgery, male gender, decreased body mass index, and increased American Society of Anesthesiologists score. When evaluated independently, the presence of cardiac arrhythmia and chronic kidney disease was strongly associated with greater mortality risk in FN fracture patients. The presence of chronic kidney disease and hypertension correlated with decreased mortality risk among FN fracture patients. (Journal of Surgical Orthopaedic Advances 27(1):64-71, 2018).