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Influence of surgical parameters on mortality after surgery for extracapsular hip fractures in the elderly
Laura Coto Caramés1, Pablo Ignacio Codesido Vilar2, Manuel Bravo Pérez1
1Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Lucus Augusti, Lugo, España.
Introduction:
Hip fracture is a very frequent traumatic pathology in the elderly with high mortality. Different factors have been associated with mortality after surgery (age comorbidities). There are surgical factors that are associated with mortality, but they have not been related to the different mortality rates and medical comorbidities.
Objective:
To analyze the surgical parameters with influence on mortality in surgery of extracapsular hip fractures in the elderly patient, as well as the influence of medical comorbidities of these patients on mortality, by means of the Charlson comorbidity index (CCI).
Method:
Retrospective review of 187 patients operated on in 2015. Data were collected on age and sex, laterality and type of fracture; surgical delay, surgical time, type of osteosynthesis material, mean stay. The presence of comorbidities was determined using the JRC.
Results:
Mean age was 85 years. Regarding the Charlson comorbidity index in brief, 67.4% of patients had a score between 0 and 1, 23.5% of 2, and 9.1% >2. Mortality at one month and one year after surgery was 5.3% and 14.4% respectively. Forty-three complications were recorded, of which 31 were medical complications. Of the 27 patients who died in the first year, 14 (51.8%) suffered complications, 48.2% of which were medical complications.
Discussion:
Multivariate analysis showed significant differences with respect to age, medical complications and Charlson index abbreviated to 2 with respect to mortality. There is no association between delay and surgical time with increased mortality.
Conclusions:
No association was demonstrated between the surgical parameters studied (surgical delay and time, fracture pattern and stability, reduction criteria, surgical complications) and increased short and long-term mortality. Patients with older age, comorbidities measured with abbreviated CCI and those suffering medical complications have a higher risk of mortality at the month and year of surgery.
