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Nontravmatik femur kırığı hastalarında mortalite ve hastanede kalış süresini etkileyen risk faktörlerinin incelenmesi

Year 2018, Volume: 15 Issue: 3, 245 - 249, 12.12.2018

Abstract

Amaç: Femur kırıkları, yaşlı hastalarda morbidite ve mortalitenin önemli bir nedenidir. Ameliyat sonrası hastalığın seyrini etkileyen faktörlerle ilgili birçok çalışma vardır. İncelenen faktörlerden bir tanesi de ameliyat öncesi bekleme süresidir. Biz bu çalışmada yaş, cinsiyet, preoperatif hemoglobin, komorbid hastalıkların varlığı ve preoperatif bekleme süresinin mortalite ve hastanede kalış suresine etkisini araştırdık.

Materyal ve Metod: Etik Kurul onayı (21 /11 /2017, 2017 / 8-23) alındıktan sonra 2015-2016 yılları arasında kliniğimizde 60 yaş ve üzeri minör travma sonrası femur kırığı tanısı alan ve anestezi yöntemi olarak kombine spinal epidural (KSE) ve spinal anestezi ile ameliyat olan 133 olgu çalışmaya dahil edildi. Hastaların yaş, cinsiyet, preoperatif hemoglobin, komorbid hastalıkların varlığı ve preoperatif bekleme süresi incelenerek bu değişkenlerin mortalite ve hastanede kalış süresi üzerine etkisine bakıldı.

Bulgular: Mortalite ve hastanede kalış süresi üzerine etkili faktörleri belirlemek için yaş, cinsiyet, ameliyat öncesi bekleme süresi, komorbid hastalık varlığı, preoperatif albümin, hemoglobin ve hematokrit değerleri retrospektif olarak incelenerek analiz edildi ve düşük hemoglobin ve hematokritin erken dönem mortalite üzerine etkili faktörler olarak tespit edildi (p=0,01). Tek başına ameliyat öncesi bekleme süresinin mortaliteye etkisinin olmadığı kanısına varıldı. Fakat ameliyat öncesi beklemenin, hastanede kalış süresini (p=0,000) etkilediği saptandı.

Sonuç: Kalça kırıklı hastalarda mortaliteye ve hastanede yatış süresine etki eden birçok faktör mevcuttur. Bu çalışmada, kalça kırığı olan yaşlı olgularda hipertansiyonun ve aneminin preoperatif dönemde düzeltilmesinin çok önemli olduğunu ve iyi bir preoperatif hazırlık yapılarak kısa zamanda ameliyat edilmesinin faydalı olacağını düşünüyoruz.

References

  • 1. Cooper C, Campion G, Melton LJ. Hip fractures in the elderly:a world-wide projection.Osteoporos Int 1992;2(6):285–9.
  • 2. Oktay Adanır, Cem Albay, Ozan Beytemür Yaşlı Hastaların Intertrokanterik Femur Kırıklarında Ameliyat Öncesi Bekleme Süresi ile Mortalite Arasındaki İlişki Okmeydanı Tıp Dergisi 2017;33(1):23-27, doi:10.5222/otd.2017.1082
  • 3. Uzoigwe CE, Burnand HG, Cheesman CL, et al. Early and ultraearlysurgery in hip fracture patients improves survival. Injury 2013;44(6):726-9. https://doi.org/10.1016/j.injury.2012.08.025. 4. Grimes JP, Gregory PM, Noveck H, Butler MS, Carson JL. The effects of time-to-surgery on mortality and morbidity in patients following hip fracture. Am J Med 2002;112(9):702-9
  • 5. Orosz GM, Magaziner J, Hannan EL, et al. Association of timing of surgery for hip fracture and patient outcomes. JAMA 2004;291(14):1738-43. https://doi.org/10.1001/jama.291.14.1738
  • 6 Majumdar SR, Beaupre LA, Johnston DW, Dick DA Cinats JG, Jiang HX. Lack of association between mortality and timing of surgical fixation in elderly patients with hip fracture: results of a retrospective populationbased cohort study. Med Care 2006;44(6):552-9. https://doi.org/10.1097/01.mlr.0000215812.13720.2
  • 7. Smith T, Pelpola K, Ball M, Ong A, Myint PK. Pre-operative indicators for mortality following hip fracture surgery:a systematic review and meta-analysis. Age Aging 2014;43(4):464–71
  • 8. Shebubakar L, Hutagalung E, Sapardan S, Sutrisna B. Effects of older age and multiple comorbidities on functional outcome after partial hip replacement surgery for hip fractures. Acta Med Indones 2009;41(4):195-99.
  • 9, Svensson O, Strömberg L, Öhlén G, Lindgren U. Prediction of the outcome after hip fracture in elderly patients. J Bone Joint Surg Br 1996;78(1):115-18. 10. Karaman S, Karaman T, Dogru S, Sahin A, Arici S. Ortopedik Cerrahi Uygulanan Geriyatrik Hastalarda Anestezi Tekniklerinin Morbitite-MortaliteÜzerine Etkisininİncelenmes. Çağdaş Tıp Dergisi 2014;4(3):143-50
  • 11. Jiang HX, Majumdar SR, Dick DA, Moreau M, Raso J, Otto DD, et al. Development and initial validation of a risk score for predicting in‐hospital and 1‐year mortality in patients with hip fractures. Journal of Bone and Mineral Research 2005;20(3):494-500.
  • 12. Soyalp C, Yuzkat N, Kılıc M, Akyol ME, Demir CY, Gulhas N. Operative and prognostic parameters associated with elective versus emergency surgery in a retrospective cohort of elderly patients. Aging clinical and experimental research, 2018; s. 1-8.
  • 13. Er S,, Çeğin MB, Göktaş U, Güner S, Yüzkat N. Ortopedi ve travmatoloji cerrahisinde anestezi yöntemlerinin retrospektif analizi Anestezi Dergisi 2015; 23 (2): 81 - 85.
  • 14. Ozturk A, Ozkan Y, Akgoz S, Yalcin N, Aykut S, Ozdemir MR. The effect of blood albumin and total lymphocyte count on short-term results in elderly patients with hip fractures. Ulus Travma Acil Cerrahi Derg 2009;15(6):546-52.
  • 15. Gruson KI, Aharonoff GB, Egol KA, Zuckerman JD, Koval KJ. The relationship between admission hemoglobin level and outcome after hip fracture. Journal of orthopaedic trauma 2002;16(1):39-44.
  • 16. Grossbard L, Desai M, Lemeshow S, Teres D. Lymphocytopenia in the surgical intensive care unit patient. The American surgeon 1984;50(4):209-12
  • 17. Chaves PH, Ashar B, Guralnik J, Fried LP. Looking at the relationship between hemoglobin concentration and prevalent mobility difficulty in older women. Should the criteria currently used to define anemia in older people be reevaluated? J Am Geriatr Soc 2002;50(7):1257–64.
  • 18. Ana BJ, Suman VJ, Fairbanks VF, Rademacher DM, Melton LJ 3rd:Incidence of anemia in older people:an epidemiologic study in a well defined population. J Am Geriatr Soc 1997;45:825–31.
  • 19. Zakai NA, Katz R, Hirsch C, Shlipak MG, Chaves PH, Newman AB,et al. A prospective study of anemia status, hemoglobin concentration, and mortality in an elderly cohort:the Cardiovasccular Health Study. Arch Intern Med 2005;165(19):2214–20.

Investigation of risk factors affecting mortality and duration of hospital stay in nontraumatic femoral fracture patients

Year 2018, Volume: 15 Issue: 3, 245 - 249, 12.12.2018

Abstract

Background: Hip fractures are an important cause of morbidity and mortality in elderly patients. There are many studies on the factors affecting the post-operative course of disease. One of the factors examined is pre-operative waiting time. In this study, we investigated the effects of age, sex, preoperative hemoglobin, presence of comorbid diseases and preoperative waiting time on mortality and hospital stay

Material and Methods: The Ethics Committee of Adiyaman University Faculty of Medicine approved this study (21 /11 /2017, 2017 / 8-23). 133 cases older than 60 years and diagnosed with minor post traumatic femur fracture and treated with combined spinal epidural (CSE) and spinal anesthesia between 2015 and 2016 were included in the study. Patients' age, sex, preoperative hemoglobin, presence of comorbid diseases and preoperative waiting time were examined and the effects of these variables on mortality and hospital stay were examined.

Results: Age, sex, preoperative waiting time, presence of comorbid diseases, preoperative albumin, hemoglobin and hematocrit values were analyzed retrospectively to determine the factors affecting the mortality and hospital stay. Low hemoclobin and hematocrit (p = 0,010) were found to be effective factors on mortality. The preoperative waiting time was found to has no effects on mortality but only has effects on hospital stay (p = 0,00).

Conclusions: There are many factors affecting mortality and hospital stay in hip fracture patients. In this study, we think that it is very important to correct hypertension and anemia in elderly patients with hip fractures in the preoperative period and it will be beneficial to perform surgery in a short time with good preoperative preparation.

References

  • 1. Cooper C, Campion G, Melton LJ. Hip fractures in the elderly:a world-wide projection.Osteoporos Int 1992;2(6):285–9.
  • 2. Oktay Adanır, Cem Albay, Ozan Beytemür Yaşlı Hastaların Intertrokanterik Femur Kırıklarında Ameliyat Öncesi Bekleme Süresi ile Mortalite Arasındaki İlişki Okmeydanı Tıp Dergisi 2017;33(1):23-27, doi:10.5222/otd.2017.1082
  • 3. Uzoigwe CE, Burnand HG, Cheesman CL, et al. Early and ultraearlysurgery in hip fracture patients improves survival. Injury 2013;44(6):726-9. https://doi.org/10.1016/j.injury.2012.08.025. 4. Grimes JP, Gregory PM, Noveck H, Butler MS, Carson JL. The effects of time-to-surgery on mortality and morbidity in patients following hip fracture. Am J Med 2002;112(9):702-9
  • 5. Orosz GM, Magaziner J, Hannan EL, et al. Association of timing of surgery for hip fracture and patient outcomes. JAMA 2004;291(14):1738-43. https://doi.org/10.1001/jama.291.14.1738
  • 6 Majumdar SR, Beaupre LA, Johnston DW, Dick DA Cinats JG, Jiang HX. Lack of association between mortality and timing of surgical fixation in elderly patients with hip fracture: results of a retrospective populationbased cohort study. Med Care 2006;44(6):552-9. https://doi.org/10.1097/01.mlr.0000215812.13720.2
  • 7. Smith T, Pelpola K, Ball M, Ong A, Myint PK. Pre-operative indicators for mortality following hip fracture surgery:a systematic review and meta-analysis. Age Aging 2014;43(4):464–71
  • 8. Shebubakar L, Hutagalung E, Sapardan S, Sutrisna B. Effects of older age and multiple comorbidities on functional outcome after partial hip replacement surgery for hip fractures. Acta Med Indones 2009;41(4):195-99.
  • 9, Svensson O, Strömberg L, Öhlén G, Lindgren U. Prediction of the outcome after hip fracture in elderly patients. J Bone Joint Surg Br 1996;78(1):115-18. 10. Karaman S, Karaman T, Dogru S, Sahin A, Arici S. Ortopedik Cerrahi Uygulanan Geriyatrik Hastalarda Anestezi Tekniklerinin Morbitite-MortaliteÜzerine Etkisininİncelenmes. Çağdaş Tıp Dergisi 2014;4(3):143-50
  • 11. Jiang HX, Majumdar SR, Dick DA, Moreau M, Raso J, Otto DD, et al. Development and initial validation of a risk score for predicting in‐hospital and 1‐year mortality in patients with hip fractures. Journal of Bone and Mineral Research 2005;20(3):494-500.
  • 12. Soyalp C, Yuzkat N, Kılıc M, Akyol ME, Demir CY, Gulhas N. Operative and prognostic parameters associated with elective versus emergency surgery in a retrospective cohort of elderly patients. Aging clinical and experimental research, 2018; s. 1-8.
  • 13. Er S,, Çeğin MB, Göktaş U, Güner S, Yüzkat N. Ortopedi ve travmatoloji cerrahisinde anestezi yöntemlerinin retrospektif analizi Anestezi Dergisi 2015; 23 (2): 81 - 85.
  • 14. Ozturk A, Ozkan Y, Akgoz S, Yalcin N, Aykut S, Ozdemir MR. The effect of blood albumin and total lymphocyte count on short-term results in elderly patients with hip fractures. Ulus Travma Acil Cerrahi Derg 2009;15(6):546-52.
  • 15. Gruson KI, Aharonoff GB, Egol KA, Zuckerman JD, Koval KJ. The relationship between admission hemoglobin level and outcome after hip fracture. Journal of orthopaedic trauma 2002;16(1):39-44.
  • 16. Grossbard L, Desai M, Lemeshow S, Teres D. Lymphocytopenia in the surgical intensive care unit patient. The American surgeon 1984;50(4):209-12
  • 17. Chaves PH, Ashar B, Guralnik J, Fried LP. Looking at the relationship between hemoglobin concentration and prevalent mobility difficulty in older women. Should the criteria currently used to define anemia in older people be reevaluated? J Am Geriatr Soc 2002;50(7):1257–64.
  • 18. Ana BJ, Suman VJ, Fairbanks VF, Rademacher DM, Melton LJ 3rd:Incidence of anemia in older people:an epidemiologic study in a well defined population. J Am Geriatr Soc 1997;45:825–31.
  • 19. Zakai NA, Katz R, Hirsch C, Shlipak MG, Chaves PH, Newman AB,et al. A prospective study of anemia status, hemoglobin concentration, and mortality in an elderly cohort:the Cardiovasccular Health Study. Arch Intern Med 2005;165(19):2214–20.
There are 17 citations in total.

Details

Primary Language Turkish
Subjects Clinical Sciences
Journal Section Research Article
Authors

Mehmet Tepe 0000-0002-2596-1284

Mevlüt Doğukan 0000-0002-4890-758X

Öznur Uludağ 0000-0002-6017-5836

Mehmet Duran 0000-0001-7568-3537

Abuzer Uludağ 0000-0003-3556-4327

Publication Date December 12, 2018
Submission Date October 22, 2018
Acceptance Date November 29, 2018
Published in Issue Year 2018 Volume: 15 Issue: 3

Cite

Vancouver Tepe M, Doğukan M, Uludağ Ö, Duran M, Uludağ A. Nontravmatik femur kırığı hastalarında mortalite ve hastanede kalış süresini etkileyen risk faktörlerinin incelenmesi. Harran Üniversitesi Tıp Fakültesi Dergisi. 2018;15(3):245-9.

Harran Üniversitesi Tıp Fakültesi Dergisi  / Journal of Harran University Medical Faculty