Perioperative complications and mortality in elderly patients following surgery for femoral fracture: prospective observational study
Complicações perioperatórias e mortalidade em pacientes idosos submetidos a cirurgia para correção de fratura de fêmur: estudo prospectivo observacional
Talita de Almeida Barbosa, André Moreira Fogaça de Souza, Fábio Caetano Oliveira Leme, Letícia Dalla Vecchia Grassi, Fabio Bussolan Cintra, Rodrigo Moreira e Lima, David Nicoletti Gumieiro, Lais Helena Navarro e Lima
Abstract
Background and objectives
Perioperative management of femoral fractures in elderly patients has been studied to determine modifiable causes of complications and death. The aim of this study was to evaluate the mortality rate and its causes in the elderly population with FF. We also evaluated perioperative complications and their association with postoperative mortality.
Method
In this prospective and observational study, we evaluated 182 patients, by questionnaire and electronic medical record, from the moment of hospitalization to one year after surgery. Statistical analyzes using the multivariate Cox proportional hazards model and Kaplan-Meier curves were performed to detect independent mortality factors.
Results
Fifty-six patients (30.8%) died within one year after surgery, and the main cause of death was infection followed by septic shock. The main complication, both preoperatively and postoperatively, was hydroelectrolytic disorder. For every one-unit (one-year) increase in age, the odds ratio for death increased by 4%. With each new preoperative complication, the odds ratio for death increased by 28%. Patients ASA III or IV had a 95% higher odds ratio for death than patients ASA I or II.
Conclusions
Increasing age and number of preoperative complications, in addition to ASA classification III or IV, were independent factors of increased risk of death in the population studied. The mortality rate was 30.8%, and infection followed by septic shock was the leading cause of death.
Keywords
Resumo
Justificativa e objetivos
O manejo perioperatório das fraturas de fêmur em pacientes idosos tem sido estudado com o intuito de determinar causas modificáveis de complicações e óbito. Este estudo tem por objetivo avaliar taxa de mortalidade e suas causas na população idosa com fraturas de fêmur. Avaliamos também complicações perioperatórias e sua associação com mortalidade pós-operatória.
Método
Neste estudo prospectivo e observacional, avaliamos 182 pacientes, por questionário e prontuário eletrônico, desde o momento da internação até um ano após a cirurgia. Análises estatísticas pelo modelo multivariado de riscos proporcionais de Cox e curvas de Kaplan-Meier foram feitas para detectar fatores independentes de mortalidade.
Resultados
Cinquenta e seis pacientes (30,8%) obituaram em até um ano de pós-operatório, sendo que a principal causa determinada de óbito foi infecção seguida de choque séptico. A principal complicação, tanto pré quanto pós-operatória, foi distúrbio hidroeletrolítico. Para cada aumento de uma unidade (em ano) na idade, a razão de chance de vir a óbito aumentou em 4%. A cada nova complicação pré-operatória apresentada, a razão de chance de óbito aumentou em 28%. Os pacientes ASA III ou IV apresentaram razão de chance de óbito, em um ano, 95% maior do que aqueles ASA I ou II.
Conclusões
O aumento da idade e do número de complicações pré-operatórias, além da classificação de ASA III ou IV foram fatores independentes de risco aumentado de óbito na população estudada. A taxa de mortalidade foi de 30,8%, sendo que infecção seguida de choque séptico foi a principal causa determinada de óbito.
Palavras-chave
References
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