Existuje nezávislý prediktor nemocniční smrtnosti pacientů s izolovanou frakturou proximálního konce femuru? Retrospektivní dvouletá observační studie

Title in English Does an Independent Predictor of In-Hospital Mortality Exist for Patients with Isolated Proximal Femoral Fracture? A Retrospective Two-Year Observational Study


Year of publication 2015
Type Article in Periodical
Magazine / Source Acta chirurgiae orthopaedicae et traumatologiae Čechoslovaca
MU Faculty or unit

Faculty of Medicine

Field Traumatology and orthopaedic surgery
Keywords proximal femoral fracture; general anaesthesia; spinal anaesthesia; in-hospital mortality
Description The primary objective of the study was to find out in-hospital mortality in patients undergoing surgery for proximal femoral fracture. The secondary objective was to identify independent predictors of in-hospital mortality. A retrospective single-centre observational study PROXIMORT of patients operated on for isolated proximal femoral fracture at the University Hospital (FN) Brno in the years 2011 and 2012. The 30-day and overall one-year mortality in the study group and the impact of observed parameters on mortality were also assessed. The observed parameters were: patient age and sex, ASA score, time from injury to surgery (hr), daily (7–20 hr) or night (20–7 hr) time of surgery, type of anaesthesia (general vs spinal), initial haemoglobin and haematocrit levels, intra-operative administration of blood products and vasopressors, and erudition of the anaesthesiologist and surgeon. To evaluate the relationship of in-hospital mortality to the observed characteristics, we used univariate logistic regression modelling and odds ratio. Data were obtained from 414 patients and 369 patients were included (male, n = 91; female, n = 278). Due to exclusion criteria, 45 patients were excluded (not an isolated injury). In-hospital mortality was 6.5% (n = 24), 30-day mortality was 8.4% (n = 31) and total mortality of the study group was 35.8% (n = 132). Statistically significant effects on in-hospital mortality included: older age of the patient (p = 0.013), ASA score of 3 or more (p = 0.002) and general anaesthesia administration (p = 0.043). For 30-day mortality, this was older age (p = 0.012), ASA score of 3 and more (p < 0.001), general anaesthesia administration (p<0.001), lower weight (p = 0.028), lower BMI (p = 0.006) and intra-operative administration of vasopressors (p = 0.023). The PROXIMORT study identified the higher patient age, ASA score of 3 and more and general anaesthesia administration as independent predictors of in-hospital mortality.

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