Does Early Surgical Fixation of Proximal Femoral Fractures in Elderly Patients Affect Mortality Rates?

Pinto, Igor Pellucci; Ferres, Luis Felipe Brandt; Boni, Guilherme; Falótico, Guilherme Guadagnini; Moraes, Maurício de; Puertas, Eduardo Barros

doi:10.1016/j.rbo.2017.12.015

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Sumário

Original Article • Rev. bras. ortop. 54 (04) • Jul-Aug 2019 • https://doi.org/10.1016/j.rbo.2017.12.015 copy

Does Early Surgical Fixation of Proximal Femoral Fractures in Elderly Patients Affect Mortality Rates?^* * Study performed at the Orthopedics and Traumatology Department, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil. Originally Published by Elsevier Editora Ltda.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To analyze whether a reduction in the waiting time for orthopedic surgery in elderly patients with fracture of the proximal end of the femur leads to a reduction in in-hospital mortality, 6-month mortality, and duration of hospitalization.

Methods

This was a retrospective cohort study including 81 patients with intertrochanteric and subtrochanteric fractures who underwent surgical repair between 2015 and 2016 in a referral hospital, before and after a protocol for early surgical fixation (< 48 hours) was implemented.

Results

Themean length of hospital stay decreased from17 to 11 days. Regarding the in-hospital mortality rate, five patients died before, and another five died after the protocol was implemented. The 6-month postoperative mortality decreased from 26.7% to 19.4%. The results showed no statistical significance.

Conclusion

The present study demonstrated that there is a tendency to reduce the length of hospital stay and 6-month mortality when the surgery for the treatment of proximal femoral fractures in the elderly is performed within 48 hours of hospitalization.

Keywords:
hip fractures; mortality; elderly; orthopedics

Length of hospital stay (days)	Before protocol implementation	After protocol implementation
Average	16.6	11.3
Median	13	8
Standard deviation	14.8	9.3
Coefficient of variation	89%	82%
Minimum value	6	2
Maximum value	108	35
N	54	27
Confidence interval	4	3.5
p-value	0.095

	Before protocol implementation		After protocol implementation		p-value
	n	%	n	%	p-value
Non-death	33	73.30%	29	80.60%	0.446
Death	12	26.70%	7	19.40%

	Before protocol implementation		After protocol implementation		p-value
	n	%	n	%	p-value
In-hospital	5	41.70%	5	71.40%	0.21
After discharge	7	53.80%	2	28.60%

Sociedade Brasileira de Ortopedia e Traumatologia Al. Lorena, 427 14º andar, 01424-000 São Paulo - SP - Brasil, Tel.: 55 11 2137-5400 - São Paulo - SP - Brazil
E-mail: rbo@sbot.org.br

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[1] Address for correspondence
Igor Pellucci Pinto, MD, Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), Rua Sena Madureira 1.500, Vila Clementino, São Paulo, SP, 04021-001, Brasil (e-mail: igor.pellucci@gmail.com).