Análisis de los factores de riesgo asociados a las complicaciones en pacientes intervenidos de fractura de cadera

Abstract

Introduction Hip fracture (HF) is a disease which affects elderly patient and is a major health problem due to its high incidence and morbidity mortality. This is a complex pathology whose etiology has been related to multiple risk factors. This disease entails a risk of medical and surgical complications during hospital stay and a catastrophic deterioration with regard to the patient&apos;s previous functional status. The patients affected are mostly elderly dependent women with comorbidity, high surgical risk and susceptible to complications. Hypothesis There are modifiable risk factors which could help us to prevent this disease from complications. Objectives The aim of this work is to identify which risk factors are associated with having complications in HF surgically operated patients in an Orthopaedic and Traumatology Surgery Service. Material and method The analysis of the risk factors for complications was carried out with a cohort of 329 patients who had undergone HF surgical operation. Data was collected from clinical histories and consisted of demographic, clinics, clinical background and analytical variables together with postoperative complications. A logistic regression model was implemented in order to see the effect of these variables within the course of complications as well as the most prevalent types of them. The SPSS statistics programme was used for the statistical analysis being p<0,05 considered statistically significant. Results The final sample of study has been constituted by 329 patients of whom 75,7% are women and 24,3% are men, aged from 38 to 98 years old with an average of 80,6 years (DT = 9,6). The appearance of complications after the surgery was observed in 38,4% of the sample&apos;s patients. According to the frequency order, the complications were: necessity of transfusion by intraoperative bleeding (60%), postoperative hematoma (38,9%), surgical wound bleeding (37,1%), exitus during the first postoperative year (27,4%), delirium during the hospitalisation (21,9%) and infection (20%). In the sample, the risk profile to suffer a complication is " Advanced age (OR=1,45; p=0,004) " To be a woman (OR=0,53; p=0,022) " ASA III-IV (OR=1,58; p=0,034) " To show a pertrochanteric fracture (OR=1,84; p=0,013) " To be operated through percutaneous surgery (OR=2,28; p=0,001; OR=8,05; p=0,018) " To show low albumin levels (OR=1,90; p=0,04) " To show low hemoglobin levels (OR=3,42; p=0,015) After the logistic regression analysis (uni and multivariable), the adjustable factors were: " Anemia, hypoproteinemia and hypoalbuminemia " To diminish hospital stay " To identify osteoporosis and to prevent falls in order to avoid pertrochanteric fractures which are the most frequent. Conclusions The identification of risk factors and high risk groups constitutes an important strategy to follow so as to reduce the incidence of complications in patients who have been operated of HF osteoporotic. Old anemic undernourished patients, with high comorbidity and pertrochanteric fracture, or those whose hospital stay is delayed, would be the most liable to complicate during the hospitalisation. Among adjustable factors we find out that low albumin, proteins and hemoglobin are associated to a bigger rate of transfusion, surgical wound bleeding or hematoma. Besides, hypoalbuminemia is associated to greater delirium and exitus rates. Acting on them help us to prevent the most frequent complications which occur in HF.