Kalça fraktürü geçirmiş hastalarda mortalite ile ilişkili faktörlerin retrospektif araştırılması

Öz

Amaç: Ortalama yaşam süresinin uzamasıyla birlikte kalça kırıklarının sayısı artmaktadır. Hasta popülasyonunun kırılgan yapısı nedeniyle kalça kırığı cerrahisinde morbidite ve mortalite oranları yüksektir. Bu çalışmada, kalça kırığı nedeniyle cerrahi tedavi uygulanan hastalarda mortalite oranlarını etkileyen faktörleri değerlendirmek amaçlandı. Yöntem: Bu çalışma, 2013-2019 tarihleri arasında Mersin ilindeki bir üniversite hastanesinin ortopedi kliniklerinde cerrahi tedavi uygulanan 599 kalça kırıklı hastanın tıbbi kayıtlarına dayanan retrospektif tanımlayıcı bir araştırmadır. Araştırmada, mortaliteyi etkileyebileceği düşünülen yaş, cinsiyet, Amerikan Anesteziyoloji Derneği risk sınıflaması (American Society of Anesthesiologists -ASA), cerrahi öncesi anemi, elektrolit dengesizliği ve glomerüler filtrasyon hızı, anestezi tipi, kan transfüzyonu, cerrahi sonrası analjezi türü, yoğun bakım ünitesinde (YBÜ) ve hastanede kalış süreleri analiz edildi. Bulgular: Yaş ve ASA sınıflaması mortalite ile anlamlı bir ilişki gösterdi (p<0.001). Bir yıl içinde yaşamını kaybedenlerin yaş ortalaması 82 yıldı ve bu hastaların %63.2’sinin ASA puanı 4’dü. Erkek hastalarda cerrahi öncesi anemi varlığı ile mortalite arasında anlamlı bir ilişki bulundu (p<0.001). Elektrolit dengesizliği olan hastalarda mortalite oranı anlamlı derecede yüksekti (p=0.003). Glomerüler filtrasyon hızı düşük olan hastalarda mortalite daha yüksekti (p<0.001). En az bir ünite kan transfüzyonu uygulanan hastalarda da mortalite oranları daha yüksekti (p<0.001). Hasta kontrollü analjezi uygulanan grubun mortalite oranı epidural ve fasya ilyaka kompartman bloğu uygulananlara kıyasla anlamlı olarak daha yüksekti (p=0.025). Yaşamını kaybeden hastaların YBÜ’de kalış süreleri hayatta kalanlara kıyasla daha uzundu (p<0.001). Sonuç: Araştırma bulguları, kalça kırığı nedeniyle cerrahi tedavi uygulanan hastalarda yaş, ASA skoru, cerrahi girişim öncesi anemi ve elektrolit dengesizliğinin, özellikle düşük glomerüler filtrasyon hızının eşlik ettiği kronik böbrek hastalığının, hasta kontrollü analjezi uygulamasının, kan transfüzyonunun, YBÜ’nde ve hastanede kalış süresinin mortalitede artış ile yakından ilişkili olduğunu gösterdi. Bu nedenle, sağ kalımı etkileyen bu risk faktörlerinin gelecekteki cerrahi planlamalarda dikkate alınması, hasta yönetiminin iyileştirilmesi ve mortalitenin azaltılması açısından önemlidir.

Anahtar Kelimeler

• kalça kırığı
• mortalite
• kalça cerrahisi

A retrospective investigation of factors associated with mortality in patients operated with hip fractures

Öz

Aim: The number of hip fractures are increasing by extension of average life expectancy. Mortality rates in hip fracture surgeries are high due to the frail nature of patient population., This study aimed to evaluate the factors affecting mortality rates in patients undergoing surgical treatment for hip fractures. Method: This is a retrospective descriptive study based on the medical records of 599 hip fracture patients who underwent surgical treatment in the orthopedic clinics of a university hospital in Mersin province between 2013-2019. Age, gender, American Society of Anesthesiologists (ASA) risk classification, preoperative anemia, electrolyte imbalance and glomerular filtration rate, type of anesthesia, erythrocyte suspension transfusion, type of postoperative analgesia, length of stay in the intensive care unit (ICU) and hospital were analyzed. Results: Age and ASA classification were significantly associated with mortality (p<0.001). The mean age of those who died within one year was 82 years, and 63.2% of these patients had an ASA score of 4. In male patients, the presence of anemia before surgery was significantly associated with mortality (p<0.001). The mortality rate was significantly higher in patients with electrolyte imbalance (p=0.003). Mortality was higher in patients with a low glomerular filtration rate (p<0.001). Mortality rates were also higher in patients who received at least one unit of blood transfusion (p<0.001). The mortality rate was significantly higher in the patient-controlled analgesia group compared to those who received epidural and fascia iliac compartment block (p=0.025). Patients who died had a longer ICU stay than those who survived (p<0.001). Conclusion: The findings of the study showed that age, ASA score, preoperative anemia and electrolyte imbalance, chronic kidney disease especially with low glomerular filtration rate, patient-controlled analgesia, blood transfusion, length of ICU and hospital stay were closely associated with increased mortality in patients undergoing surgical treatment for hip fracture. Therefore, it is important to consider these risk factors affecting survival in future surgical planning to improve patient management and reduce mortality.

Anahtar Kelimeler

• hip fracture
• mortality
• hip surgery

Kaynakça

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