Ruiz-Romero María Victoria, Fernández-Ojeda María Del Rocío, Castilla Yélamo Javier, García-Benítez José Boris, Calero-Bernal María Luz, Fernández-Moyano Antonio
Unidad de Calidad e Investigación. Hospital San Juan de Dios del Aljarafe (Bormujos). Sevilla. España.
Servicio de Medicina Interna. Hospital San Juan de Dios del Aljarafe (Bormujos). Sevilla. España.
Rev Esp Salud Publica. 2020 Nov 26;94:e202011142.
In spite of technical advances, hip fracture causes high mortality in the elderly. We wanted to know early surgery influence to mortality during admission, one year and after five years, as well as readmissions at one month and one year. We also wanted to know how dependence and Health-Related Quality of Life (HRQOL) evolved in the twelve months of follow-up and what factors were associated with poor patient evolution.
A prospective observational study was made in patients over 65 years of age treated for osteoporotic hip fracture in a level III hospital between 2010- 2012, with consecutive sampling. We evaluated functionality (Barthel) and quality of life (EuroQol-5D) basal (before fracture), within 30 days, within six and twelve months; readmissions within the 30 days and within one year; and mortality during admission; within one and five years. We used the statistical program SPSS Version 25.0 for the statistical analysis.
We followed 327 patients of 82.9 (SD: 6.9) years of means, 258 (78.9%) were women. Fifty-four (45.9%) were treated within 24 hours and 237 (72.5%) within 48 hours. They returned 14 (4.3%) within the 30 days and 44 (13.5%) within the one year. There were 8 deaths during admission (2.4%) and 61 (19.2%) in the first year and 185 (54,6%) within five years. The pre-fracture quality of life was 0.43 median (0.24-0.74), at the month 0.15 (0.07-0.28), at six months 0.26 (0, 13-0.59) and at twelve 0.24 (0.15-0.58). The previous functionality was 85.0 (55.0-100) at the month 35.0 (20.0-60.0) and 60.0 (25.0-85.0) at six and twelve months. There were significant differences between all visits except between six and twelve months.
The patients get worse significantly at the month of surgery and recover in the six months, remaining at twelve, without reaching the baseline value. The results in mortality and readmissions per year are worse for men and older. Early surgery does not reduce mortality, but re-admissions to the year.
尽管技术不断进步，但髋部骨折在老年人中仍导致高死亡率。我们想了解早期手术对住院期间、一年及五年后的死亡率的影响，以及一个月和一年后的再入院情况。我们还想了解在十二个月的随访中，患者的依赖程度和健康相关生活质量（HRQOL）如何变化，以及哪些因素与患者的不良预后相关。
对2010年至2012年期间在一家三级医院接受骨质疏松性髋部骨折治疗的65岁以上患者进行了一项前瞻性观察研究，采用连续抽样。我们评估了患者骨折前（基础状态）、30天内、六个月和十二个月时的功能（Barthel指数）和生活质量（欧洲五维健康量表）；30天内和一年内的再入院情况；以及住院期间、一年内和五年内的死亡率。我们使用统计软件SPSS 25.0进行统计分析。
我们随访了327例平均年龄为82.9岁（标准差：6.9岁）的患者，其中258例（78.9%）为女性。54例（45.9%）在24小时内接受治疗，237例（72.5%）在48小时内接受治疗。30天内有14例（4.3%）患者再入院，一年内有44例（13.5%）患者再入院。住院期间有8例死亡（2.4%），第一年有61例（19.2%）死亡，五年内有185例（54.6%）死亡。骨折前生活质量中位数为0.43（0.24 - 0.74），术后1个月为0.15（0.07 - 0.28），六个月时为0.26（0.13 - 0.59），十二个月时为0.24（0.15 - 0.58）。骨折前功能评分为85.0（55.0 - 100），术后1个月为35.0（20.0 - 60.0），六个月和十二个月时分别为60.0（25.0 - 85.0）。除六个月和十二个月之间外，所有随访时间点之间均存在显著差异。
患者在手术当月病情显著恶化，并在六个月时恢复，但在十二个月时仍未恢复到基线值。男性和年龄较大者每年的死亡率和再入院率结果更差。早期手术并不能降低死亡率，但可降低一年内的再入院率。
