Experience in the perioperative management of patients with hip fracture in southwestern Colombia. Retrospective cohort study
Abstract
Introduction: Hip fracture is one of the main causes of morbidity and mortality among the elderly population. In Colombia there is a shortage of scientific literature on the perioperative management of this population of patients.
Objective: To describe the perioperative management of hip fracture patients at a tertiary university hospital in Cali, Colombia.
Methods: An observational study was conducted with relational scope of a historical cohort of patients with hip fracture who underwent surgical management between January 2018 and June 2022. A non-probability sampling method was used and contingency tables were designed aimed at describing the relationship between the patients’ characteristics and the postoperative outcomes.
Results: 235 patients were included, of which 57 % were males. The mean age was 79 years and 49.8 % were classified as ASA III or higher. Spinal anesthesia was the most commonly used technique in 63.4 % of the cases. The most frequent outcomes were delirium in 17.9 %, and acute kidney failure in 6.8 %. 83.4 % of the patients underwent surgery within 48 hours of admission to the emergency department and intra-hospital mortality was 2.6 %.
Conclusion: The results of this study provide relevant information to identify opportunities for improvement and their implementation, such as the reduction in the time elapsed until surgical management and the development of care protocols in the region.
References
Cooper C, Campion G, Melton LJ 3rd. Hip fractures in the elderly: a world-wide projection. Osteoporos Int. 1992;2(6):285-9. doi: 10.1007/BF01623184. doi: https://doi.org/10.1007/BF01623184
González L, Vásquez G, Molina J. Epidemiology of osteoporosis. Rev Colomb Reumatol. 2009;16(1):61-75. doi: https://doi.org/10.1016/S0121-8123(09)70119-7
Buse GL, Bhandari M, Sancheti P, Rocha S, Winemaker M, Adili A, et al. Accelerated care versus standard care among patients with hip fracture: The HIP ATTACK pilot trial. CMAJ. 2014;186(1). doi: https://doi.org/10.1503/cmaj.130901
Merchán-Galvis Á, Muñoz DA, Solano F, Velásquez JC. Delay in hip fracture surgery and its outcomes. A reflection. Colombian Journal of Anesthesiology. 2021;49(1). doi: https://doi.org/10.5554/22562087.e915
National Cancer Institute. Perioperative Management [Internet]. [cited 2 Jul 2022]. Available at: https://www.cancer.gov/publications/dictionaries/cancer-terms/def/perioperative
Neuman MD, Ellenberg SS, Sieber FE, Magaziner JS, Feng R, Carson JL. Regional versus General Anesthesia for Promoting Independence after Hip Fracture (REGAIN): protocol for a pragmatic, international multicentre trial. BMJ Open. 2016;6:13473. doi: https://doi.org/10.1136/bmjopen-2016-013473
Tafur A, Douketis J. Perioperative management of anticoagulant and antiplatelet therapy. Heart. 2018;104(17):1461-7. doi: https://doi.org/10.1136/heartjnl-2016-310581
Tarrant SM, Kim RG, McGregor KL, Palazzi K, Attia J, Balogh ZJ. Dual antiplatelet therapy and surgical timing in geriatric hip fracture. J Orthop Trauma. 2020;34(10):559-65. doi: https://doi.org/10.1097/BOT.0000000000001779
Simunovic N, Devereaux PJ, Sprague S, Guyatt GH, Schemitsch E, DeBeer J, et al. Effect of early surgery after hip fracture on mortality and complications: Systematic review and meta-analysis. CMAJ. Canadian Medical Association. 2010;182:1609-16. doi: https://doi.org/10.1503/cmaj.092220
Bhandari M, Koo H, Saunders L, Shaughnessy SG, Dunlop RB, Schemitsch EH. Predictors of in-hospital mortality following operative management of hip fractures. Int J Surg Investig. 1999;1(4):319-26.
Uribe Ríos A, Castaño Herrera DA, García Ortega AN, Pardo Aluma EE. Morbilidad y mortalidad en pacientes mayores de 60 años con fractura de cadera en el Hospital Universitario San Vicente Fundación, de Medellín, Colombia. Iatreia. 2012;25(4):305-13. doi: https://doi.org/10.17533/udea.iatreia.13104
Odén A, McCloskey E, Kanis JA, Harvey NC, Johansson H. Burden of high fracture probability worldwide: secular increases 2010-2040. Osteoporosis Internat. 2015;26(9):2243-8. doi: https://doi.org/10.1007/s00198-015-3154-6
Caicedo Sanguino DF, Araque Melo AE, Rojas Quintero NR, Villamizar Quintero SE. Epidemiology of hip fracture in adults treated at a tertiary level hospital. Rev Invest Salud Universidad de Boyacá. 2020;7(2). doi: https://doi.org/10.24267/23897325.551
National Hip Fracture Database [Internet]. s.f. [cited 2022 Jun 11]. Available at: https://www.nhfd.co.uk
Martínez Rondanelli A. Hip fractures in the elderly: prognosis, epidemiology. Overview: Experience. Rev Colomb Ortop Traumatol. 2005;19(1)20-8.
Jiang M, Liu S, Deng H, Liang X, Bo Z. The efficacy and safety of fast track surgery (FTS) in patients after hip fracture surgery: a meta-analysis. J Orthopaedic Surg Rese. BioMed Central. 2021;16. doi: https://doi.org/10.1186/s13018-021-02277-w
Seong YJ, Shin WC, Moon NH, Suh KT. Timing of hip-fracture surgery in elderly patients: Literature review and recommendations. Hip Pelvis. 2020;32(1):11. doi: https://doi.org/10.5371/hp.2020.32.1.11
Rostagno C, Ranalli C, Polidori G, Cartei A, Boccaccini A, Peris A. Outcome in elderly patients with aortic stenosis undergoing hip fracture surgery. Results may suggest a different postoperative strategy? Trauma Surg Acute Care Open. 2019;4(1): e000218. doi: https://doi.org/10.1136/tsaco-2018-000218
Halvorsen S, Mehilli J, Cassese S, Hall TS, Abdelhamid M, Barbato E, et al. 2022 ESC Guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery. Eur Heart J. 2022;43(39):3826-924. doi: https://doi.org/10.1093/eurheartj/ehac270
Eagle KA, Berger PB, Calkins H, Chaitman BR, Ewy GA, Fleischmann KE, et al. ACC/AHA Guideline Update for Perioperative Cardiovascular Evaluation for Noncardiac Surgery-Executive Summary A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1996 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery) Committee Members [Internet]. 2002 [cited 2023 Apr 12]. Available at: www.acc.org
Moran CG, Wenn RT, Sikand M, Taylor AM. Early mortality after hip fracture: Is delay before surgery important?. 2005;87(3):483-89. doi: https://doi.org/10.2106/JBJS.D.01796
Smektala R, Endres HG, Dasch B, Maier C, Trampisch HJ, Bonnaire F, et al. The effect of time-to-surgery on outcome in elderly patients with proximal femoral fractures. BMC Musculoskelet Disord. 2008;9:171. doi: https://doi.org/10.1186/1471-2474-9-171
Hadzic A. Spinal or general anesthesia for hip fracture [Internet]. 2022 [cited 2023 Jan 11]. Available at: https://www.nysora.com/news/spinal-or-general-anesthesia-for-hip-fracture/
Beaudoin FL, Haran JP, Liebmann O. A comparison of ultrasound-guided three-in-one femoral nerve block versus parenteral opioids alone for analgesia in emergency department patients with hip fractures: A randomized controlled trial. Acad Emerg Med. 2013;20(6):584-91. doi: https://doi.org/10.1111/acem.12154
Griffiths R, Babu S, Dixon P, Freeman N, Hurford D, Kelleher E, et al. Guideline for the management of hip fractures 2020: Guideline by the Association of Anaesthetists. Anaesthesia. 2021;76(2):225-37. doi: https://doi.org/10.1111/anae.15291
Neuman MD, Feng R, Carson JL, Gaskins LJ, Dillane D, Sessler DI, et al. Spinal anesthesia or general anesthesia for hip surgery in older adults. New Eng J Med. 2021;385(22):2025-35. doi: https://doi.org/10.1056/NEJMoa2113514
Quan S, Pannu N, Wilson T, Ball C, Tan Z, Tonelli M, et al. Prognostic implications of adding urine output to serum creatinine measurements for staging of acute kidney injury after major surgery: A cohort study. Nephrol Dialysis Transplant. 2016;31(12):2049-56. doi: https://doi.org/10.1093/ndt/gfw374
Yang Z, Ni J, Long Z, Kuang L, Gao Y, Tao S. Is hip fracture surgery safe for patients on antiplatelet drugs and is it necessary to delay surgery? A systematic review and meta-analysis. J Orthop Surg Res. 2020;15(1). doi: https://doi.org/10.1186/s13018-020-01624-7
Collinge CA, Kelly KC, Little B, Weaver T, Schuster RD. The effects of clopidogrel (plavix) and other oral anticoagulants on early hip fracture surgery [Internet]. [cited 2023 Apr 12]. Available at: www.jorthotrauma.com
Papachristos I, Giannoudis P. Proximal femur fractures in patients taking anticoagulants. EFORT Open Rev. 2020;5(10):700-6. doi: https://doi.org/10.1302/2058-5241.5.190071
Godier A, Dincq AS, Line Martin AC, Radu A, Leblanc I, Antona M, et al. Predictors of pre-procedural concentrations of direct oral anticoagulants: A prospective multicentre study. Eur Heart J. 2017;38(31):2431-9. doi: https://doi.org/10.1093/eurheartj/ehx403
Gibson AA, Hay AW, Ray DC. Patients with hip fracture admitted to critical care: Epidemiology, interventions and outcome. Injury. 2014;45(7):1066-70. doi: https://doi.org/10.1016/j.injury.2014.02.037
Griffiths R, Alper J, Beckingsale A, Goldhill D, Heyburn G, Holloway J, et al. Management of proximal femoral fractures 2011: Association of Anaesthetists of Great Britain and Ireland. Anaesthesia. 2012;67:85-98. doi: https://doi.org/10.1111/j.1365-2044.2011.06957.x
Nurmi I, Narinen A, Lüthje P, Tanninen S. Functional outcome and survival after hip fracture in elderly: A prospective study of 106 consecutive patients. J Orthopaedics Traumatol. 2004;5(1):7-14. doi: https://doi.org/10.1007/s10195-004-0033-x
Caicedo-Correa SM, Aruachan-Torres SA, Segura-Valencia AI, Chavarro-Carvajal DA. Asociación del estado nutricional y funcional en ancianos con fractura de cadera. Acta Med Colomb. 2019;44(1):7-10. doi: https://doi.org/10.36104/amc.2019.1035
Downloads
Copyright (c) 2020 Sociedad Colombiana de Anestesiología y Reanimación (S.C.A.R.E.)
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
| Article metrics | |
|---|---|
| Abstract views | |
| Galley vies | |
| PDF Views | |
| HTML views | |
| Other views | |
