Mortalidad intrahospitalaria en adultos mayores chilenos con fractura de cadera: incidencia, causas y otros elementos de interés

Resumen

Introducción Las fracturas de cadera (FC) presentan alta mortalidad. Existen escasos estudios que profundizan en la mortalidad intrahospitalaria (MIH) asociada.

Objetivo Describir MIH en pacientes ≥ 60 años con FC.

Materiales y Métodos Corte transversal, descriptivo y analítico, monocéntrico, de colección completa. Fueron evaluados 647 sujetos, de ambos géneros, ingresados con FC entre 01.01.2010 y 31.12.2012, agrupándolos en fallecidos y egresados vivos. Se registró fallecimientos, género, edad, ubicación anatómica, tipo de traumatismo, lugar de ocurrencia de FC, tiempo fractura-fallecimiento, tiempo de estancia hospitalaria, porcentaje de operados, diagnósticos asociados a FC, diagnóstico de fallecimiento, comorbilidad asociada al diagnóstico de fallecimiento y lugar de fallecimiento. Datos en planilla ortogeriátrica, análisis descriptivo.

Resultados MIH = 3,09%. Edad promedio 84 años. Los diagnósticos de fallecimiento más importantes fueron infecciones (40%) y enfermedad tromboembólica (15%). El 80% presentó comorbilidad crónica relacionada con la causa de fallecimiento. Sin diferencias significativas según edad, género, ubicación anatómica de la FC, lugar de ocurrencia de la FC, tiempo de estancia hospitalaria. Hubo diferencias significativas en cantidad de no operados, mayor en el grupo con MIH (p < 0.000), esperable por sesgo de selección. Es deseable identificar precozmente los sujetos con FC que presentan alto riesgo de MIH. Esto, para definir manejo conservador, optimizar calidad de vida y recursos hospitalarios.

Abstract

Introduction Hip fractures (HIF), have high rates of early mortality. However, there are few studies that deepen in in-hospital mortality (IHM).

Objective To describe IHM in patients with ≥ 60 years with HIF.

Materials and Methods Cross-sectional, descriptive and analytical, monocentric, full collection. 647 subjects, both genders, admitted with HIF between 01.01.2010 and 12.31.2012, separating them in inhospital deceased and discharged alive. Registered deaths, gender, age, anatomic location, type of trauma, place of occurrence of HIF, time fracture-death, length of hospital stay, percentage of operated, diagnosis associated with HIF, diagnosis of death, comorbidity associated with the diagnosis of death and place of death. Data in orthogeriatric chart, descriptive analysis.

Results IHM = 3.09%. Average age 84 years. The most important diagnoses of death were infections (40%) and thromboembolic disease (15%). 80% presented chronic comorbidity related to the cause of death. There were no significant differences according to age, gender, HIF anatomical location, place of occurrence of the HIF, length of hospital stay. There were significant differences in the number of non-operated, higher in the IHM group (p < 0.000), expected for selection bias. It is desirable to identify early those subjects with HIF who are at high risk for IHM. This, to define conservative management, optimize quality of life and hospital resources.

Palabras Clave

Mortalidad intrahospitalaria - Fractura de cadera - Ortogeriatría

Keywords

in-hospital mortality - hip fracture - orthogeriatrics

Financiación

Los autores declaran ausencia de financiamientos para esta investigación.

• Bibliografía

• 1 Porto-Carriero F, Christmas C. In the Clinic: Hip Fracture. Ann Intern Med 2011; 155 (11) ITC6-1-ITC6-15
• 2 Cornwall R, Gilbert MS, Koval KJ, Strauss E, Siu AL. Functional outcomes and mortality vary among different types of hip fractures: a function of patient characteristics. Clin Orthop Relat Res 2004; (425) 64-71
• 3 Kanis JA, Odén A, McCloskey EV, Johansson H, Wahl DA, Cooper C. ; IOF Working Group on Epidemiology and Quality of Life. A systematic review of hip fracture incidence and probability of fracture worldwide. Osteoporos Int 2012; 23 (09) 2239-2256
• 4 Dinamarca-Montecinos JL, Améstica-Lazcano G, Rubio-Herrera R, Carrasco-Buvinic A, Vásquez A. Hip fracture. Experience in 647 Chilean patients aged 60 years or more. Rev Med Chil 2015; 143 (12) 1552-1559
• 5 Brozek W, Reichardt B, Kimberger O. , et al. Mortality after hip fracture in Austria 2008-2011. Calcif Tissue Int 2014; 95 (03) 257-266
• 6 Bredahl C, Nyholm B, Hindsholm KB, Mortensen JS, Olesen AS. Mortality after hip fracture: results of operation within 12 h of admission. Injury 1992; 23 (02) 83-86
• 7 Cree M, Soskolne CL, Belseck E. , et al. Mortality and institutionalization following hip fracture. J Am Geriatr Soc 2000; 48 (03) 283-288
• 8 Hamlet WP, Lieberman JR, Freedman EL, Dorey FJ, Fletcher A, Johnson EE. Influence of health status and the timing of surgery on mortality in hip fracture patients. Am J Orthop 1997; 26 (09) 621-627
• 9 Belmont Jr PJ, Garcia EJ, Romano D, Bader JO, Nelson KJ, Schoenfeld AJ. Risk factors for complications and in-hospital mortality following hip fractures: a study using the National Trauma Data Bank. Arch Orthop Trauma Surg 2014; 134 (05) 597-604
• 10 O'Connor I, McDowell D, Barnes D. Hip Fractures: The St Ann's Bay Regional Hospital Experience. West Indian Med J 2014; 63 (02) 138-141
• 11 Martínez-Rondanelli A. Fracturas de cadera en ancianos: pronóstico, epidemiología. Aspectos generales: experiencia. Rev Col de Or Tra 2005; 19 (01) 20-28 . Disponible en: http://www.sccot.org.co/pdf/RevistaDigital/19-01-2005/05Fracturas.pdf
• 12 Giannoulis D, Calori GM, Giannoudis PV. Thirty-day mortality after hip fractures: has anything changed?. Eur J Orthop Surg Traumatol 2016; 26 (04) 365-370
• 13 Guide to Inpatient Quality Indicators: Quality of Care in Hospitals Volume, Mortality, and Utilization. Department of Health and Human Services. Agency for Healthcare Research and Quality, June 2002. Version 3.1 (March 12, 2007), pags 56–57. http://www.qualityindicators.ahrq.gov
• 14 Sociedad Española de Calidad Asistencial. Indicadores de Calidad para Hospitales del Sistema Nacional de Salud, marzo 2012, p 65. Disponible en: http://www.calidadasistencial.es/images/gestion/biblioteca/335.pdf
• 15 Compston J, Cooper A, Cooper C. , et al. Guideline for the diagnosis and management of osteoporosis. The National Osteoporosis Guideline Group, 2014
• 16 Zeltzer J, Mitchell RJ, Toson B, Harris IA, Ahmad L, Close J. Orthogeriatric services associated with lower 30-day mortality for older patients who undergo surgery for hip fracture. Med J Aust 2014; 201 (07) 409-411
• 17 Vidán MT, Vaquero J. Unidades de ortogeriatría: Impacto en los resultados de la fractura de cadera en el anciano. En Fracturas femorales en el anciano. Cap 4, 51–56. 2013 SECOT–AAOS. Disponible en http://www.secot.es/descargas/monografias/2013/monografia_2013_3.pdf
• 18 Tarrant SM, Hardy BM, Byth PL, Brown TL, Attia J, Balogh ZJ. Preventable mortality in geriatric hip fracture inpatients. Bone Joint J 2014; 96-B [phone]
• 19 Serra JA, Garrido G, Vidán M, Marañón E, Brañas F, Ortiz J. Epidemiology of hip fractures in the elderly in Spain. An Med Interna 2002; 19 (08) 389-395
• 20 Pioli G, Barone A, Giusti A. , et al. Predictors of mortality after hip fracture: results from 1-year follow-up. Aging Clin Exp Res 2006; 18 (05) 381-387
• 21 Shoda N, Yasunaga H, Horiguchi H. , et al. Risk factors affecting inhospital mortality after hip fracture: retrospective analysis using the Japanese Diagnosis Procedure Combination Database. BMJ Open 2012; 2 (03) e000416
• 22 Sancho CA, Arguedas C. Epidemiología de la fractura de cadera de origen osteoporótico en Costa Rica en un período de cinco años. Rev Esp Enferm Metab Oseas 2000; 2 (09) 66-69 . Disponible en: http://www.elsevier.es/en-revista-reemo-70-articulo-epidemiologia-de-la-fractura-de-10016982
• 23 Hu F, Jiang C, Shen J, Tang P, Wang Y. Preoperative predictors for mortality following hip fracture surgery: a systematic review and meta-analysis. Injury 2012; 43 (06) 676-685
• 24 Myers AH, Robinson EG, Van Natta ML, Michelson JD, Collins K, Baker SP. Hip fractures among the elderly: factors associated with in-hospital mortality. Am J Epidemiol 1991; 134 (10) 1128-1137
• 25 Choi HG, Lee YB, Rhyu SH, Kwon BC, Lee JK. Mortality and cause of death postoperatively in patients with a hip fracture. Bone Joint J 2018; Apr 1; 100-B [phone]
• 26 Aharonoff GB, Koval KJ, Skovron ML, Zuckerman JD. Hip fractures in the elderly: predictors of one year mortality. J Orthop Trauma 1997; 11 (03) 162-165
• 27 Dawe EJ, Lindisfarne E, Singh T, McFadyen I, Stott P. Sernbo score predicts survival after intracapsular hip fracture in the elderly. Ann R Coll Surg Engl 2013; 95 (01) 29-33
• 28 Moppett IK, Wiles MD, Moran CG, Sahota O. The Nottingham Hip Fracture Score as a predictor of early discharge following fractured neck of femur. Age Ageing 2012; 41 (03) 322-326
• 29 Nijmeijer WS, Folbert EC, Vermeer M, Slaets JP, Hegeman JH. Prediction of early mortality following hip fracture surgery in frail elderly: The Almelo Hip Fracture Score (AHFS). Injury 2016; 47 (10) 2138-2143
• 30 Moppett IK, Parker M, Griffiths R, Bowers T, White SM, Moran CG. Nottingham Hip Fracture Score: longitudinal and multi-assessment. Br J Anaesth 2012; 109 (04) 546-550
• 31 Kesmezacar H, Ayhan E, Unlu MC, Seker A, Karaca S. Predictors of mortality in elderly patients with an intertrochanteric or a femoral neck fracture. J Trauma 2010; 68 (01) 153-158
• 32 Karagiannis A, Papakitsou E, Dretakis K. , et al. Mortality rates of patients with a hip fracture in a southwestern district of Greece: ten-year follow-up with reference to the type of fracture. Calcif Tissue Int 2006; 78 (02) 72-77
• 33 Altadill Arregui A, Gomez Alonso C, Virgós Soriano MJ, Diaz López B, Cannata Andía JB. Epidemiology of hip fracture in Asturias. Med Clin (Barc) 1995; 105 (08) 281-286
• 34 Foss NB, Kehlet H. Mortality analysis in hip fracture patients: implications for design of future outcome trials. Br J Anaesth 2005; 94 (01) 24-29
• 35 Kondo A, Yamaguchi C, Fujimoto E. Relationship between admission day and timing of surgery for patients with hip fracture. Jpn J Nurs Sci 2014; 11 (04) 248-258
• 36 Ceballos García G, Castro Campillo G. La muerte en el anciano. Cap 9, “el lugar de la muerte”, pp 67–75. Tesina de Diplomatura en Tanatología. Ediciones de la Asociación Mexicana de Tanatología y Asociación Mexicana de educación continua y a distancia. México DF, 2014. Disponible en http://www.tanatologia-amtac.com/descargas/tesinas/149%20La%20muerte.pdf
• 37 González-Montalvo JI, Alarcón T, Hormigo Sánchez AI. Why do hip fracture patients die?. Med Clin (Barc) 2011; 137 (08) 355-360
• 38 Chatterton BD, Moores TS, Ahmad S, Cattell A, Roberts PJ. Cause of death and factors associated with early in-hospital mortality after hip fracture. Bone Joint J 2015; 97-B [phone]