Geriatrik Kalça Kırıklarında Mortaliteyi Etkileyen Peroperatif Parametrelerin Değerlendirilmesi

Bu çalışmanın amacı, kalça kırığı nedeniyle cerrahi tedavi uygulanan geriatrik hastalarda mortaliteyi etkileyen potansiyel risk faktörlerini değerlendirmektir.Yöntemler: Kalça kırığı nedeniyle ameliyat edilen ve erken postoperatif dönemden itibaren takibi yapılabilen 65 yaş üstü 116 hasta (46 erkek ve 70 kadın; ortalama yaş 77,6 yıl) çalışmaya alındı. Hastalara femur boyun kırığı, intertrokanterik kırık ve subtrokanterik kırık nedeni ile cerrahi tedavi uygulanmıştı. Hastalar, mortaliteyi etkileyen faktörler arasında olan cerrahi yöntem, yaş, cerrahi zamanı, hastanede kalış süresi, eşlik eden sistemik hastalıklar ve cerrahi sonrası erken mobilizasyon açısından değerlendirildi. Bulgular: On iki (2 erkek/10 kadın) hastanın çeşitli sebeplerle öldüğü tespit edildi. İlk bir ayda 2 (%1,7), 1-3 ayda 4 (%3,4), 3-6 ay arasında 1 (%0,9) ve 6-12 ay arasında 5 (%4,3) hastanın öldüğü tespit edildi. Hastalarda görülen ölüm nedenleri olarak kardiopulmoner yetmezlik (7 hasta), emboli ve ileri yaş olduğu öğrenildi. Ölen hasta grubunda ASA skoru, yaş, üç ve üzerinde sistemik hastalık varlığı, hastanede kalış süresi ve mobilizasyon zamanı yaşayan hasta grubuna göre anlamlı olarak yüksekti. Seçilen cerrahi yöntemin mortalite sayısı üzerine anlamlı etkisi gözlenmedi.Sonuç: Kalça kırığı sonrası cerrahi tedavi planlanan geriatrik hastalar cerrahi öncesinde tüm genel sağlık durumları ile birlikte değerlendirilmelidir. İleri yaş ve yüksek ASA skoru mortalite oranlarını artırmaktadır. Hastanın erken zamanda cerrahi için stabil hale getirilerek hastanede kalış süresi ve cerrahi zamanın kısaltılması peroperatif komplikasyonları azaltacaktır. Bununla birlikte kırık tipine ve hastaya uygun cerrahi yöntem seçilerek erken mobilizasyon sağlanması mortalite oranını azaltmak için önemli bir etkendir

Assessment of Peroperative Parameters Affecting Mortality in Geriatric Hip Fractures

The aim of the present study was to evaluate the potential risk factors affecting mortality in geriatric patients undergoing surgical operations for hip fractures.Methods: One-hundred and sixteen patients (46 males, 70 females; mean age, 77.6 years) who were older than 65 years and had been operated on for hip fractures and followed from the early postoperative period were included in the study. The patients underwent surgical treatment for a femoral neck, intertrochanteric fracture, and subtrochanteric fractures. Patients were evaluated in terms of age, surgical time, length of hospital stay, accompanying systemic diseases, and mobilization timing for risk factors affecting mortality.Results: Twelve patients (2 male, 10 female) died of various medical diseases. Two (1.7%) patients died in the first month, 4 (3.4%) between the 1st and the 3rd month, 1 (0.9%) between the 3rd and the 6th month, and 5 (4.3%) between the 6th and 12th month. The causes of death in these patients were cardiopulmonary failure (n=7), pulmonary embolism, and old age. ASA scores of the group of non-survivor patients were significantly higher compared with the group of survivor patients in terms of age, the presence of 3 or more systemic diseases, the duration of hospital stay, and mobilization time. There was no significant correlation between the surgical procedure chosen and the mortality rate.Conclusion: Geriatric patients for whom hip fracture surgery is planned should be evaluated together with their general health status before surgery. Advanced age and high ASA scores increase the risk of mortality. Early preparation of the patient for surgery will shorten the duration of hospital stay and time until surgery and consequently will reduce perioperative complications. In addition, early mobilization by selecting the appropriate surgery method for the fracture type and the patient is a significant factor in reducing mortality

Kaynakça

Cauley JA, Thompson DE, Ensrud KC, Scott JC, Black D. Risk of mortality following clinical fractures. Osteoporos Int 2000; 11: 556- 61. [CrossRef]

Center JR, Nguyen TV, Schneider D, Sambrook PN, Eisman JA. Mor- tality after all major types of osteoporotic fracture in men and wo- men: an observational study. Lancet 1999; 353: 878-82. [CrossRef]

Nguyen ND, Eisman JA, Center JR, Nguyen TV. Risk factors for frac- ture in nonosteoporotic men and women. J Clin Endocrinol Metab 2007; 92: 955-62. [CrossRef]

Jiang HX, Majumdar SR, Dick DA, Moreau M, Raso J, Otto DD, et al. Development and initial validation of a risk score for predicting in-hospital and 1-year mortality in patients with hip fractures. J Bone Miner Res 2005; 20: 494-500. [CrossRef]

Gullberg B, Johnell O, Kanis JA. World-wide projections for hip frac- ture. Osteoporos Int 1997; 7: 407-13. [CrossRef]

Johnell O, Kanis JA. An estimate of the worldwide prevalence, mortality and disability associated with hip fracture. Osteoporos Int 2004; 15: 897-902. [CrossRef]

Bergström U, Björnstig U, Stenlund H, Jonsson H, Svensson O. Frac- ture mechanisms and fracture pattern in men and women aged 50 years and older: a study of a 12-years population-based register, Umea, Sweden. Osteoporos Int, 2008; 19: 1267-73. [CrossRef]

Haentjens P, Magaziner J, Colon-Emeric CS, Vanderschueren D, Mi- lisen K, Velkeniers B, et al. Meta-analysis: excess mortality after hip fracture among older women and men. Ann Intern Med 2010; 152: 380-90. [CrossRef]

Clague JE, Craddock E, Andrew G, Horan MA, Pendleton N. Pre- dictors of outcome following hip fracture. Admission time pre- dicts length of stay and in-hospital mortality. Injury 2002; 33: 1-6. [CrossRef]

Katelaris AG, Cumming RG. Health status before and mortality after hip fracture. Am J Public Health 1996; 86: 557-60. [CrossRef]

Poor G, Atkinson EJ, O'Fallon WM, Melton III LJ. Predictors of hip fractures in elderly men. J Bone Miner Res 1995; 10: 1900-7. [CrossRef]

Kanis JA, Oden A, Johnell O, De Laet C, Jonsson B, Oglesby AK. The components of excess mortality after hip fracture. Bone 2003; 32: 468-73. [CrossRef]

Magaziner J, Lydick E, Hawkes W, Fox KM, Zimmerman SI, Epstein RS, et al. Excess mortality attributable to hip fracture in white wo- men aged 70 years and older. Am J Public Health 1997; 87: 1630-6. [CrossRef]

Kenzora JE, McCarthy RE, Lowell JD, Sledge CB. Hip fracture morta- lity. Clin Orthop Relat Res 1984; 186: 45-56. [CrossRef]

Rogmark C, Carlsson A, Johnell O, Sernbo I. Primary hemiarthrop- lasty in old patients with displaced femoral neck fracture: a 1-year follow-up of 103 patients aged 80 years or more. Acta Orthop Scand 2002; 73: 605-10. [CrossRef]

Casaletto JA, Gatt R. Post-operative mortality related to waiting time for hip fracture surgery. Injury 2004; 35: 114-20. [CrossRef]

Fisher AA, Davis MW, Rubenach SE, Sivakumaran S, Smith PN, Bud- ge MM. Outcomes for older patients with hip fractures: the impact of orthopedic and geriatric medicine cocare. J Orthop Trauma 2006; 20: 172-80. [CrossRef]

Vidan M, Serra JA, Moreno C, Riquelme G, Ortiz J. Efficacy of a comprehensive geriatric intervention in older patients hospitalized for hip fracture: a randomized, controlled trial. J Am Geriatr Soc 2005; 53: 1476-82. [CrossRef]

Wehren LE, Magaziner J. Hip fracture: risk factors and outcomes. Curr Osteoporos Rep 2003; 1: 78-85. [CrossRef]

Abrahamsen B, Van Staa T, Ariely R, Olson M, Cooper C. Excess mor- tality following hip fracture: a systematic epidemiological review. Os- teoporos Int 2009; 20: 1633-50. [CrossRef]

Pande I, Scott DL, O'Neill TW, Pritchard C, Woolf AD, Davis MJ. Qu- ality of life, morbidity, and mortality after low trauma hip fracture in men. Ann Rheum Dis 2006; 65: 87-92. [CrossRef]

Brossa Torruella A, Tobias Ferrer J, Zorrilla Ribeiro J, Lopez Borras E, Alabart Teixido A, Belmonte Garridof M. Mortality after hip fracture: a three year follow-up study. Med Clin 2005; 124: 53-4. [CrossRef]

McLeod K, Brodie MP, Fahey PP, Gray RA. Long-term survival of sur- gically treated hip fracture in an Australian regional hospital. Ana- esth Intensive Care 2005; 33: 749-55.

Cannada L, Schmidt A. The effect of surgical timing on elderly hip fracture patient outcomes. An updated systematic review and meta- analysis. Bone Joint Evidence 2011; 1: 1-15.

Sexson SB, Lehner JT. Factors affecting hip fracture mortality. J Ort- hop Trauma 1987; 1: 298-305. [CrossRef]

Owens WD, Felts JA, Spitznagel EL Jr. ASA physical status classifi- cations: a study of consistency of ratings. Anesthesiology 1978; 49: 239-43. [CrossRef]

Fleisher LA. Risk of anesthesia. In: Miller RD, editor. Miller's anesthe- sia. Vol 1, 6th ed. USA: Elsevier; 2005. p. 893-925.

White BL, Fisher WD, Laurin CA. Rate of mortality for elderly patients after frac- ture of the hip in the 1980's. J Bone Joint Surg Am 1987; 69: 1335-40. [CrossRef]

Cohen MM, Duncan PG, Tate RB. Does anesthesia contribute to operative mortality? JAMA 1988; 260: 2859-63. [CrossRef]

Pedersen T, Eliasen K, Henriksen E. A prospective study of mortality associated with anesthesia and surgery: risk indicators of mortality in hospital. Acta Anaesthesiol Scand 1990; 34: 176-82. [CrossRef]

Shah SN, Wainess RM, Karunakar MA. Hemiarthroplasty for femoral neck fracture in the elderly. Surgeon and hospital volume-related outcomes. J Arthroplasty 2005; 20: 503-8. [CrossRef]

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