2015, Number 5
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AMC 2015; 19 (5)
Morbidity and mortality related to the anesthetic method in hip fracture
García ÁPJ, Cabreja ME, Estrada BY
Language: Spanish
References: 27
Page: 450-458
PDF size: 524.53 Kb.
ABSTRACT
Background: hip fracture is the most frequent cause of surgery in patients older than 65. Its incidence has increased and mortality doubles in people of this age.
Objectives: to assess the impact of the anesthetic method, of comorbidities and of the delay of surgery on mortality and hospital stay.
Results: the average age was 84 years ± 9, 3 years. The 95 % of the patients suffered from high blood pressure; the 51, 1% presented heart diseases. The 42 % of the patients suffered any type of delay of the surgery. The 51, 1 % presented complications. Global mortality was of a 13 %. General anesthesia was related to an increase in mortality (11 %) x
2 =0, 61, Odd Ratio= 8, 6 and an increase in the postoperative complications (29%) x
2 =0.77; Odd Ratio= 1.8. The comorbidities (84 %) of the patients were related to an increase in the mortality X
2=0.67; Odd Ratio= 1.58. The hospital stay carried on after the general anesthesia x
2 =0.91; Odd Ratio= 7.7. The delay of surgery was related to an increase in the mortality x
2 =0.18; Odd Ratio= 8.9.
Conclusions: neuraxial anesthesia reduced the mortality in the postoperative period. General anesthesia was related to a greater number of complications. The related diseases were a risk factor of postoperative mortality. The hospital stay carried on after the general anesthesia. Delay in the surgical procedure was another factor that influenced on the mortality.
REFERENCES
Serra J, Garrido G, Vidán M, Marrañón E, Brañas F, Ortiz J. Epidemiología de la fractura de cadera en ancianos en España. An Med Interna (Madrid). 2002 Feb;56(19):389-395.
Radiæ N, Radinoviæ K, Ille M, Lesiæ A, Ljubi-ciæ S, Bumbasireviæ Z. The selection of best an-esthesiological technique for hip fracture surgery in older high-risk patients [Internet]. 2012 Nov [cited 2015 May 12];59(3):[about 2 p.]. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23654020
García Raga S. Factores pronósticos de muerte en pacientes operados de fractura de cade-ra. Rev cuba anestesiol reanim [Internet]. Dic 2011 [citado 12 May 2015];10(3):[aprox. 9 p.]. Disponible en: http://scieloprueba.sld.cu/scielo.php?script=sci_arttext&pid=S1726-67182011000300006&lng=es&nrm=iso .
Basora M, Colomina M. Anestesia en cirugía ortopédica y en traumatología. 1st ed. En: Basora M, Colomina M, editors. Madrid: Editorial médica Panamericana; 2011. p. 124-231.
Parker M, Handoll H, Griffiths R. Anestesia para la cirugía por fractura de cadera en adultos [base de datos en Internet]. London: Cochrane Database of Systematic Reviews. c2014 [actualizado 1 Ene 2014; citado 10 May 2015]. Disponible en: http://www.cochrane.org/es/CD000521/anes
Bess Constantén S. Anuario Estadistico de Salud en Cuba [Internet]. La Habana: MINSAP; 2014 [citado 12 May 2015]. Disponible en: http://www.sld.cu/sitios/dne/.
Amer N. Early operation on patientes with a hip fracture improved the ability to return to inde-pendent living. A prospective study of 850 pa-tients. J Bone Joint Surg Am. 2008 Feb;3(90):1436-1442.
González Montalvo JI. ¿Por qué fallecen los pacientes con fractura de cadera? Medicina Clínica [Internet]. Sep 2011 [citado 12 May 2015];137(8):[aprox. 7 p.]. Disponible en: http://www.sciencedirect.com/science/article/pii/S0025775310007505 .
Ferré F, Minville V. Preoperative manage-ment to reduce morbidity and mortality of hip frac-ture. Ann Fr Anesth Reanim [Internet]. 2011 [cited 2015 May 12];30(10):[about 4 p.]. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21945704
Müller E, Gerstorfer I, Dovjak P, Iglseder B, Pinter G, Müller , et al. Procedural organisation: surgical and anaesthesiological management in hip fractures. Wien Med Wochenschr [Internet]. 2013 Oct [cited 2015 May 12];163:[about 2 p.]. Availa-ble from: http://www.ncbi.nlm.nih.gov/pubmed/24201598
Rae H, Harris I, McEvoy L, Todorova T. Delay to surgery and mortality after hip fracture. ANZ J Surg [Internet]. 2007 Oct [cited 2015 May 12];77(10):[about 3 p.]. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17803557
Pérez Reyes R, Pons Mayea GO, Otero Ceba-llos M. Evaluación del protocolo de fractura de ca-dera en la urgencia, Unidad de Cuidados Interme-dios Quirúrgicos. Rev Cub Med Mil [Internet]. Sep-Dic 2004 [citado 12 May 2015];33(4):[aprox. 2 p.]. Disponible en: http://scieloprueba.sld.cu/scielo.php?script=sci_arttext&pid=S0138-65572004000400005&lng=es&nrm=iso
Haberer J. Anestesia del paciente anciano. EMC - Anestesia-Reanimación [Internet]. Feb 2014 [citado 12 May 2015];40(1):[aprox. 18 p.]. Dispo-nible en: http://www.sciencedirect.com/science/article/pii/S128047031366644X
Lo I, Siu C, Tse H, Lau T, Leung F, Wong M. Pre-operative pulmonary assessment for patients with hip fracture. Osteoporos Int [Internet]. 2010 Dec [cited 2015 May 12];21(4):[about 7 p.]. Avail-able from: http://www.ncbi.nlm.nih.gov/pubmed/21057997
Albavera Gutiérrez RR, López García R, Anto-nio Romero CE, Gurrola Mendoza K, Montero Qui-jano MG, Pérez Solares A, et al. Mortalidad de pa-cientes con fractura de cadera a cinco años de evolución en el Hospital Regional General Ignacio Zaragoza. Rev Esp Méd Quir [Internet]. 2013 [citado 12 May 2015];54(1):[aprox. 4 p.]. Disponi-ble en: http://test.elsevier.es/ficheros/sumarios/1/69/1574/23/1v69n1574a13078750pdf001.pdf .
Juste Lucero M. Morbimortalidad asociada a la fractura de cadera del paciente anciano. Análisis de nuestro medio [tesis]. Barcelona: Universidad Autónoma de Barcelona; 2012.
Pedersen S, Borgbjerg F, Schousboe B. A comprehensive hip fracture program reduces com-plication rates and mortality. J Am Geriatr Soc. 2008 Aug;(56):1831-1838.
Sandby Thomas M, Sullivan G, Hall E. A na-tional survery into the peri-operative anesthetic managament of patientes presenting for surgical correction of a fractured neck of femur. Anaesthe-sia. 2008 Jul;63:250-258.
Urcin S, Parker M, Griffiths R. General versus restional aneaesthesia for hip fracture surgery: a meta-analysis of randomized trials. Brit J Anaesth. 2000 Nov;(84):450-455.
Sieber FE, Pauldine R. Geriatric Anesthesia. In: Miller RD, editor. Miller´s Anesthesia. Pennsyl-vania: Churchil-Linvingstone; 2012. p. 2261-2277.
Amigo Castañeda P, Rodríguez Díaz M, Cas-tañeda Gueimonde CM. Comportamiento intrahos-pitalario entre las fracturas de cadera intracapsula-res y las extracapsulares. Rev Cubana Ortop Trau-matol [Internet]. Ene-Jun 2012 [citado 12 May 2015];26(1):[aprox. 12 p.]. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0864-215X2012000100003
Neuman M, Rosenbaum P, Ludwig J, Zubizar-reta J, Silber J. Anesthesia technique, mortality, and length of stay after hip fracture surgery. JAMA [Internet]. 2014 Jun [cited 2015 May 12];311(24):[about 9 p.]. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25058085
Neuman M, Silber J, Elkassabany N, Ludwig J, Fleisher L. Comparative effectiveness of regional versus general anesthesia for hip fracture surgery in adults. Anesthesiology [Internet]. 2012 Jul [cited 2015 May 12];117(1):[about 20 p.]. Availa-ble from: http://www.ncbi.nlm.nih.gov/pubmed/22713634
Brown DL. Anesthesia Management.Spinal, Epidural, and Caudal Anesthesia. In: Miller RD, ed-itor. Miller´s Anesthesia. Pennsylvania: Curchil- Livingstone; 2012. 1611-1638.
Opperer M, Danninger T, Stundner O, Memtsoudis SG. Perioperative outcomes and type of anesthesia in hip surgical patients: An evidence based review. World J Orthop [Internet]. 2014 Jul [cited 2015 May 12];5(3):[about 7 p.]. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4095027/.
McLaughlin M, Orosz G, Magaziner J. Pre-operative status risk of complications in patients with hip fracture. J Gen Intern Med [Internet]. 2006 Mar [cited 2015 May 12];14(21):[about 6 p.]. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2974919/.
Rae H, Harris I, McEvoy L, Todorova T. Delay to surgery and mortality after hip fracture. ANZ J Surg [Internet]. 2007 Oct [cited 2015 May 12];77(10):[about 4 p.]. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17803557