Análisis de los factores de riesgo de mortalidad al año en pacientes con fractura de cadera osteoporótica en España: un estudio observacional prospectivo

  • Shuai-Suai Gao Universidad de Sevilla
  • Yong-Feng Yao
  • Aurelio Borrás Verdara
  • Wen-Ting Zhang
  • Yan-Jun Wang
Palabras clave: fractura de cadera, osteoporosis, mortalidad, factores de riesgo

Resumen

Objetivo  Analizar los factores de riesgo que inciden en la mortalidad al año de las fracturas de cadera osteoporóticas en España.  Materiales y métodos Fue un estudio observacional prospectivo. Los pacientes con fractura de cadera que fueron intervenidos quirúrgicamente en el Hospital Universitario Virgen Macarena de Sevilla, España del 1 de enero de 2017 al 31 de diciembre de 2017. Se recopiló la información requerida a través de registros de historia clínica y seguimiento. Se realizó un análisis de factor único para descartar los factores con p<0,1, y luego estos factores se incluyeron en el análisis de regresión de Cox para averiguar los factores de riesgo independientes para la mortalidad posoperatoria al año.  Resultados Se incluyeron un total de 426 participantes, 107 hombres (25,1%) y 319 mujeres (74,9%). Durante el seguimiento de un año fallecieron 81 casos (19,0%). Hubo 7 factores de riesgo independientes relacionados con la tasa de mortalidad al año de las fracturas de cadera osteoporóticas en España: Los factores de riesgo inmodificables incluyeron los niveles de actividad previos a la lesión, ASA grado 4 y enfermedad pulmonar combinada. Los factores de riesgo prevenibles incluyeron complicaciones respiratorias, complicaciones cardiovasculares, complicaciones cerebrovasculares, y trombosis venosa.  Conclusión La tasa de mortalidad de las fracturas de cadera osteoporóticas en España es relativamente alta, pero mediante la prevención activa de las complicaciones postoperatorias, la tasa de mortalidad puede disminuir.  

Citas

Veronese N, Maggi S. Epidemiology and social costs of hip fracture. Injury. 2018; 49(8): 1458-60. doi:10.1016/j.injury.2018.04.015. https://pubmed.ncbi.nlm.nih.gov/29699731/.

Tolar J, Teitelbaum SL, Orchard PJ. Osteopetrosis. New England Journal of Medicine. 2004; 351(27): 2839-49. doi:10.1056/NEJMra040952. https://pubmed.ncbi.nlm.nih.gov/15625335/

Rashki Kemmak A, Rezapour A, Jahangiri R, Nikjoo S, Farabi H, Soleimanpour S. Economic burden of osteoporosis in the world: A systematic review. Med J Islam Repub Iran. 2020; 34(154-. doi:10.34171/mjiri.34.154. https://pubmed.ncbi.nlm.nih.gov/33437750/

Peeters CM, Visser E, Van de Ree CL, Gosens T, Den Oudsten BL, De Vries J. Quality of life after hip fracture in the elderly: A systematic literature review. Injury. 2016; 47(7): 1369-82. doi:10.1016/j.injury.2016.04.018. https://pubmed.ncbi.nlm.nih.gov/27178770/

Guzon-Illescas O, Perez Fernandez E, Crespí Villarias N, Quirós Donate FJ, Peña M, Alonso-Blas C, et al. Mortality after osteoporotic hip fracture: incidence, trends, and associated factors. Journal of orthopaedic surgery and research. 2019; 14(1): 203. doi:10.1186/s13018-019-1226-6. https://pubmed.ncbi.nlm.nih.gov/31272470/

Huette P, Abou-Arab O, Djebara A-E, Terrasi B, Beyls C, Guinot P-G, et al. Risk factors and mortality of patients undergoing hip fracture surgery: a one-year follow-up study. Scientific reports. 2020; 10(1): 9607. doi:10.1038/s41598-020-66614-5. https://pubmed.ncbi.nlm.nih.gov/32541939/

Chang W, Lv H, Feng C, Yuwen P, Wei N, Chen W, et al. Preventable risk factors of mortality after hip fracture surgery: Systematic review and meta-analysis. International journal of surgery (London, England). 2018; 52(320-8. doi:10.1016/j.ijsu.2018.02.061. https://pubmed.ncbi.nlm.nih.gov/29530826/

Serra JA, Garrido G, Vidán M, Marañón E, Brañas F, Ortiz J. Epidemiology of hip fractures in the elderly in Spain. Anales de medicina interna (Madrid, Spain : 1984). 2002; 19(8): 389-95. https://pubmed.ncbi.nlm.nih.gov/12244785/

Azagra R, López-Expósito F, Martin-Sánchez JC, Aguyé A, Moreno N, Cooper C, et al. Changing trends in the epidemiology of hip fracture in Spain. Osteoporos Int. 2014; 25(4): 1267-74. doi:10.1007/s00198-013-2586-0. https://pubmed.ncbi.nlm.nih.gov/24322478/

RUIZ-ROMERO MV, FERNÁNDEZ-OJEDA MR, CASTILLA YELÁMO J, et al. Influencia de la cirugía precoz de la fractura de cadera en ancianos en la mortalidad, los reingresos, la dependencia y la calidad de vida. Revista Española de Salud Pública, 2020, vol. 94, no 1, p. e1-e13. https://pubmed.ncbi.nlm.nih.gov/33226013/

INE. Population structure Indicators. Available from: https://www.ine.es/jaxiT3/Tabla.htm?t=1488.

Rey-Rodriguez MM, Vazquez-Gamez MA, Giner M, Garrachón-Vallo F, Fernández-López L, Colmenero MA, et al. Incidence, morbidity and mortality of hip fractures over a period of 20 years in a health area of Southern Spain. BMJ open. 2020; 10(9): e037101. doi:10.1136/bmjopen-2020-037101. https://pubmed.ncbi.nlm.nih.gov/32973058/

Jorissen RN, Lang C, Visvanathan R, Crotty M, Inacio MC. The effect of frailty on outcomes of surgically treated hip fractures in older people. Bone. 2020; 136(115327. doi:10.1016/j.bone.2020.115327. https://pubmed.ncbi.nlm.nih.gov/32209422/

Aslan A, Atay T, Aydoğan NH. Risk factors for mortality and survival rates in elderly patients undergoing hemiarthroplasty for hip fracture. Acta Orthop Traumatol Turc. 2020; 54(2): 138-43. doi:10.5152/j.aott.2020.02.298. https://pubmed.ncbi.nlm.nih.gov/32254028/

Bolton CE, Ionescu AA, Shiels KM, Pettit RJ, Edwards PH, Stone MD, et al. Associated loss of fat-free mass and bone mineral density in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2004; 170(12): 1286-93. doi:10.1164/rccm.200406-754OC. https://pubmed.ncbi.nlm.nih.gov/15374843/

Hakamy A, Bolton CE, Gibson JE, McKeever TM. Risk of fall in patients with COPD. Thorax. 2018; 73(11): 1079-80. doi:10.1136/thoraxjnl-2017-211008. https://pubmed.ncbi.nlm.nih.gov/29563161/

Yamauchi Y, Yasunaga H, Sakamoto Y, Hasegawa W, Takeshima H, Urushiyama H, et al. Mortality associated with bone fractures in COPD patients. Int J Chron Obstruct Pulmon Dis. 2016; 11:2335-40. doi:10.2147/copd.S112142. https://pubmed.ncbi.nlm.nih.gov/27703343/

Buss L, McKeever TM, Nightingale J, Akyea R, Ollivere B, Moppett IK, et al. Hip fracture outcomes in patients with chronic obstructive pulmonary disease. British Journal of Anaesthesia. 2018; 121(6): 1377-9. doi:10.1016/j.bja.2018.09.008. https://pubmed.ncbi.nlm.nih.gov/30442271/

Cha YH, Ha YC, Park HJ, Lee YK, Jung SY, Kim JY, et al. Relationship of chronic obstructive pulmonary disease severity with early and late mortality in elderly patients with hip fracture. Injury. 2019; 50(9): 1529-33. doi:10.1016/j.injury.2019.05.021. https://pubmed.ncbi.nlm.nih.gov/31147182/

Quach LH, Jayamaha S, Whitehouse SL, Crawford R, Pulle CR, Bell JJ. Comparison of the Charlson Comorbidity Index with the ASA score for predicting 12-month mortality in acute hip fracture. Injury. 2020; 51(4): 1004-10. doi:10.1016/j.injury.2020.02.074. https://pubmed.ncbi.nlm.nih.gov/32151423/

Barceló M, Torres OH, Mascaró J, Casademont J. Hip fracture and mortality: study of specific causes of death and risk factors. Arch Osteoporos. 2021; 16(1): 15. doi:10.1007/s11657-020-00873-7. https://pubmed.ncbi.nlm.nih.gov/33452949/

Bohl DD, Sershon RA, Saltzman BM, Darrith B, Della Valle CJ. Incidence, Risk Factors, and Clinical Implications of Pneumonia After Surgery for Geriatric Hip Fracture. J Arthroplasty. 2018; 33(5): 1552-6.e1. doi:10.1016/j.arth.2017.11.068. https://pubmed.ncbi.nlm.nih.gov/29289445/

Lin YC, Lee SH, Chen IJ, Chang CH, Chang CJ, Wang YC, et al. Symptomatic pulmonary embolism following hip fracture: A nationwide study. Thromb Res. 2018; 172(120-7. doi:10.1016/j.thromres.2018.10.014. https://pubmed.ncbi.nlm.nih.gov/30412833/

Smeets SJM, van Wunnik BPW, Poeze M, Slooter GD, Verbruggen J. Cardiac overscreening hip fracture patients. Arch Orthop Trauma Surg. 2020; 140(1): 33-41. doi:10.1007/s00402-019-03270-z. https://pubmed.ncbi.nlm.nih.gov/31471640/

Atzmon R, Sharfman ZT, Efrati N, Shohat N, Brin Y, Hetsroni I, et al. Cerebrovascular accidents associated with hip fractures: morbidity and mortality-5-year survival. Journal of orthopaedic surgery and research. 2018; 13(1): 161. doi:10.1186/s13018-018-0867-1. https://pubmed.ncbi.nlm.nih.gov/29954421/

Mitchell R, Harvey L, Brodaty H, Draper B, Close J. One-year mortality after hip fracture in older individuals: the effects of delirium and dementia. Arch Gerontol Geriatr. 2017; 72(135-41. doi:10.1016/j.archger.2017.06.006. https://pubmed.ncbi.nlm.nih.gov/28628893/

Choi HG, Lee YB, Rhyu SH, Kwon BC, Lee JK. Mortality and cause of death postoperatively in patients with a hip fracture: a national cohort longitudinal follow-up study. The bone & joint journal. 2018; 100-b(4): 436-42. doi:10.1302/0301-620x.100b4.Bjj-2017-0993. https://pubmed.ncbi.nlm.nih.gov/29629585/

Yoon JY, Kim S, Chang JS, Yoon PW, Kim JW. Venous thromboembolism after delayed surgery for a hip fracture: A retrospective cohort study. Geriatr Gerontol Int. 2020; 20(12): 1151-6. doi:10.1111/ggi.14055. https://pubmed.ncbi.nlm.nih.gov/33058481/

Zhang BF, Wei X, Huang H, Wang PF, Liu P, Qu SW, et al. Deep vein thrombosis in bilateral lower extremities after hip fracture: a retrospective study of 463 patients. Clin Interv Aging. 2018; 13(681-9. doi:10.2147/cia.S161191. https://pubmed.ncbi.nlm.nih.gov/29713152/

Durand WM, Goodman AD, Johnson JP, Daniels AH. Assessment of 30-day mortality and complication rates associated with extended deep vein thrombosis prophylaxis following hip fracture surgery. Injury. 2018; 49(6): 1141-8. doi:10.1016/j.injury.2018.03.019. https://pubmed.ncbi.nlm.nih.gov/29580646/

Morri M, Ambrosi E, Chiari P, Orlandi Magli A, Gazineo D, D' Alessandro F, et al. One-year mortality after hip fracture surgery and prognostic factors: a prospective cohort study. Scientific reports. 2019; 9(1): 18718-. doi:10.1038/s41598-019-55196-6. https://pubmed.ncbi.nlm.nih.gov/31822743/

Groff H, Kheir MM, George J, Azboy I, Higuera CA, Parvizi J. Causes of in-hospital mortality after hip fractures in the elderly. Hip international. 2020; 30(2): 204-9. doi:10.1177/1120700019835160. https://pubmed.ncbi.nlm.nih.gov/30909746/

Salvador Marín J, Ferrández Martínez FJ, Fuster Such C, Seguí Ripoll JM, Orozco Beltrán D, Carratalá Munuera MC, et al. Factores de riesgo para el ingreso prolongado y mortalidad intrahospitalaria en la fractura del fémur proximal en pacientes mayores de 65 años. Revista Española de Cirugía Ortopédica y Traumatología. 2021; doi:10.1016/j.recot.2020.11.008.

Guerra MT, Viana RD, Feil L, Feron ET, Maboni J, Vargas AS. One-year mortality of elderly patients with hip fracture surgically treated at a hospital in Southern Brazil. Rev Bras Ortop. 2017; 52(1): 17-23. doi:10.1016/j.rboe.2016.11.006. https://pubmed.ncbi.nlm.nih.gov/28194376/

Guidelines. SIN. Management of hip fracture in older people. Available from: https://www.sign.ac.uk/assets/sign111.pdf.

Yaacobi E, Marom O, Gutman N, Zabarqa S, Brin Y, Ohana N. Mortality following surgery for geriatric hip fractures: is it the timing or the co-morbidities? Hip international. 2020; 1120700020945942. doi:10.1177/1120700020945942. https://pubmed.ncbi.nlm.nih.gov/32718199/

Saul D, Riekenberg J, Ammon JC, Hoffmann DB, Sehmisch S. Hip Fractures: Therapy, Timing, and Complication Spectrum. Orthopaedic surgery. 2019; 11(6): 994-1002. doi:10.1111/os.12524. https://pubmed.ncbi.nlm.nih.gov/31568676/

S-S. Gao, W-T. Zhang, G-X. Zhang. Aplicación Flexible de las Guías para el Manejo de la Fractura de Cadera: Compartir la Experiencia Clínica. Revista de la Sociedad Andaluza de Traumatología y Ortopedia. 2020;37(1/4): 39-50.

Pang C, Aqil A, Mannan A, Thomas G, Hossain FS. Hip fracture patients admitted to hospital on weekends are not at increased risk of 30-day mortality as compared with weekdays. Journal of Orthopaedics and Traumatology. 2020; 21(1): 23. doi:10.1186/s10195-020-00558-4. https://pubmed.ncbi.nlm.nih.gov/33263820/

Sciard D, Cattano D, Hussain M, Rosenstein A. Perioperative management of proximal hip fractures in the elderly: the surgeon and the anesthesiologist. Minerva Anestesiol. 2011; 77(7): 715-22. https://pubmed.ncbi.nlm.nih.gov/21283071/

Porter CJ, Moppett IK, Juurlink I, Nightingale J, Moran CG, Devonald MA. Acute and chronic kidney disease in elderly patients with hip fracture: prevalence, risk factors and outcome with development and validation of a risk prediction model for acute kidney injury. BMC Nephrol. 2017; 18(1): 20. doi:10.1186/s12882-017-0437-5. https://pubmed.ncbi.nlm.nih.gov/28088181/

Ju JB, Zhang PX, Jiang BG. Hip Replacement as Alternative to Intramedullary Nail in Elderly Patients with Unstable Intertrochanteric Fracture: A Systematic Review and Meta-Analysis. Orthopaedic surgery. 2019; 11(5): 745-54. doi:10.1111/os.12532. https://pubmed.ncbi.nlm.nih.gov/31663280/

Kuru T, Olçar HA. Effects of early mobilization and weight bearing on postoperative walking ability and pain in geriatric patients operated due to hip fracture: a retrospective analysis. Turkish journal of medical sciences. 2020; 50(1): 117-25. doi:10.3906/sag-1906-57. https://pubmed.ncbi.nlm.nih.gov/31742370/

Dahl C, Holvik K, Meyer HE, Stigum H, Solbakken SM, Schei B, et al. Increased Mortality in Hip Fracture Patients Living Alone: A NOREPOS Study. Journal of bone and mineral research. 2021; 36(3): 480-8. doi:10.1002/jbmr.4212. https://pubmed.ncbi.nlm.nih.gov/33403722/

Publicado
2022-12-07
Sección
Articulos Originales