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Evidence-based Practice and Quality Improvement

Morbidity and mortality associated with hip fracture in the elderly patient. Analysis of our environment

1AP6-5

Juste, Lucero M.; Colomina, Soler M.J.; Abreo, Ariza A.; López, Guerrero E.; Sierra, Casado E.; Arbelaez, Arango A.

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European Journal of Anaesthesiology (EJA): June 2013 - Volume 30 - Issue - p 22-22
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Background and Goal of Study: Hip fracture is a prevalent condition in the elderly population, with exponential growth, high rates of morbidity and mortality associated with quality of life and healthcare consumption.

We determine the epidemiological variables and mortality, we describe the causes of surgical delay and its consequences and the impact on health care and the process involved for adequate provision of resources.

Methods/Design: We performed a retrospective observational study reviewing all patients with a diagnosis of hip fracture operated in our hospital between January 2007 and December 2008. We recorded general epidemiological facts, antiplatelet/anticoagulation treatment, type of anesthesia and complications, transfusion rate, hospital stay, surgical delay and mortality among others. We also performed a predictive model of death at 30 days and one year using logistic regression and multivariate analysis. The variables of interest (gender, age, ASA, comorbidity, baseline hemoglobin, admission diagnosis, infectious or general complications and surgical delay), setting the statistical significance at p < 0.05.

Results: 765 patients were included, 78% being females, average age 83 (± 7.33). 59.8% of patients were ASA III. 35.5% had some type of treatment prescribed antiplatelet or anticoagulant. Trasfusional rate was 52.5% with a median of 2.25 units. We found a surgical delay on an average of two days due to antiplatelet / anticoagulant treatment, baseline disease decompensation and operating room availability. The cumulative incidence of death at 30 days was 6.9% and 23.5% annually. The multivariate analysis of our predictive study with logistic regression showed the risk factors associated with increased 30-day mortality were gender related (OR 4.49 in males), age related (OR 1.077), ASA (OR 1.75), postoperative complications (OR 7.1) and surgical delay (OR 1.92), being statistically significant.

The same predictive study was performed to know the mortality rate at 12 months; the variables related to late mortality were gender (OR 3.06 in males), age (OR 1.072), ASA (OR 2.25), thus showing more impact in the annual mortality risk than mortality at 30 days. Baseline haemoglobin was evidenced as a protective factor (OR 0.879, p = 0.022).

Conclusions: Surgical delay results in increased postoperative complications and a higher mortality rate. Hip fracture is a serious problem, with important implications in the immediate and long-term costs.

© 2013 European Society of Anaesthesiology