ABSTRACT
Propósito del estudio: Explorar las preferencias educativas de los beneficiarios adultos de las Garantías Explicitas en Salud (GES) sometidos a una cirugía de endoprótesis total de cadera. Material y método: Estudio descriptivo de carácter mixto. Se diseñó una encuesta que exploró las preferencias educativas referentes a cada etapa del proceso quirúrgico de adultos mayores sometidos electivamente a endoprótesis total de cadera en un centro hospitalario universitario. La encuesta se aplicó retrospectivamente de manera telefónica por un encuestador entrenado. El tiempo transcurrido entre la aplicación de la encuesta y la cirugía fue entre 2 y 14 meses. Resultados: Se incluyeron 63 pacientes, cuya edad promedio fue 72,5 años y el 69,8% correspondía al sexo femenino. Con respecto a su previsión de salud el 57,2% era beneficiario de FONASA y el 42,7% de ISAPRE. Las preferencias de información descritas en nuestra muestra con respecto al proceso quirúrgico desde su inicio a fin, señalan a la cirugía propiamente tal (40,4%) y los cuidados post operatorios (29,3%) como los temas de más interés. Los temas de menor interés fueron los relacionados con cuidados preoperatorios (45,2%) y al proceso de hospitalización (31,7%). Los pacientes encuestados valoraron la información entregada previa a su cirugía como adecuada, útil y fácil de entender. Conclusiones: Los adultos mayores sometidos a endoprótesis señalaron la información específica referente a la cirugía y los cuidados post operatorios como los temas educativos de mayor interés. La información estándar entregada por los médicos tratantes fue bien recibida por los pacientes.
Purpose of the study: To explore the educational preferences of adults aged 65 years and older with hip osteoarthritis undergoing total hip replacement (THA). Methods: Mixed descriptive study. A survey was designed to explore the educational preferences regarding each stage of the surgical process in elderly patients undergoing electively THA for osteoarthritis in a university-affiliated hospital. The survey was applied retrospectively and telephonically by a trained interviewer between 2 and 14 months after the surgery.Results: Sixty-three patients were surveyed, whose average age was 72.5 years, and 69.8% corresponded to females. Regarding their health coverage, 57.2% were beneficiaries of FONASA and 42.7% of ISAPRE. The educational preferences described in our sample regarding the surgical process from its beginning to the end indicate that surgery (40.4%) and post-operative care (29.3%) as the most relevant topics. The topics of least interest were preoperative care (45.2%) and information related to hospitalization (31.7%). The surveyed pa-tients rated their treating physician's education as adequate, helpful, and easy to understand before their surgery. Conclusions: Elderly patients undergoing THA indicated that specific surgery and post-operative care information are the most relevant educational topics.
ABSTRACT
BACKGROUND: Every year about 9 million fragility fractures (FF) occur worldwide and 80% of these are underdiagnosed or undertreated. Aiming to close the gap of diagnosis and treatment of osteoporosis, Fracture Liaison Services (FLS) were developed. AIM: To describe the implementation of the first FLS in Chile, its inclusion criteria, patient enrolment, treatment adherence and referrals during the first year. MATERIAL AND METHODS: A FLS was implemented at a health care network composed by two hospitals. The International Osteoporosis Foundation (IOF) guidelines were applied with a nurse practitioner as the coordinator. From May 2020 to April 2021 all patients diagnosed with a FF in the emergency rooms were invited to participate. Patients with pathological fractures and active cancer were excluded. Demographical data, fracture location, previous fractures, treatment and adherence, and mortality were recorded. RESULTS: From 443 patients with a diagnosis of FF, 177 patients (40%) accepted to participate. Their mean age was 74 ± 13 years and 84% (149) were female. Forty eight percent (84) had a lower extremity FF. Hip fractures were the most common (67). Ninety-five patients reported previous FF and 11,2% (20) had received anti-osteoporotic treatment. At four months of follow-up, 62% (50) had received vitamin D and calcium supplementation and 20% (16) of those patients with an indication of anti-osteoporotic drugs, had received them. CONCLUSIONS: The implementation of the FLS was successful with a 40% enrolment of patients, receiving certification by the IOF.
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Osteoporosis/diagnosis , Osteoporosis/drug therapy , Osteoporotic Fractures/prevention & control , Vitamin D/therapeutic use , Bone Density Conservation Agents/therapeutic use , Secondary Prevention , Hip FracturesABSTRACT
Background: As the population ages, patients exposed to osteoporotic fractures increase, especially hip fracture, which is the most severe and costly. Aim: To characterize surgical practices in the management of hip fractures in older patients through a nationwide survey of specialized hip surgeons dedicated to the care of these patients. Material and Methods: A survey composed of 32 questions was formulated, including demographic factors, preoperative evaluation, definitive treatment, and postoperative management. It was sent to 140 specialists. 84 of them replied (61%), and 71 answers were included. Results: Eighty six percent of respondents agreed that orthogeriatric management is fundamental in the outcome of these patients, but only 73% had the collaboration of an internist or a geriatrician. Although 97% considered 72 hours or less the ideal time to perform surgery, only 52% of the respondents declared performing surgery within that timeframe, with differences between private and public system. Regarding surgical treatment, 94-98% of femoral neck fractures are treated with an arthroplasty and 98-99% of per-subtrochanteric fractures are treated with internal fixation and osteosynthesis. Osteoporosis treatment is only carried out by 51% of the respondents and with significant variation. Conclusions: This survey shows that there is agreement in surgical practice between specialists treating these patients, but clear differences in preoperative optimization, treatment timeframe, and post fracture medical treatment.
Subject(s)
Humans , Middle Aged , Aged , Practice Patterns, Physicians'/statistics & numerical data , Surveys and Questionnaires , Orthopedic Surgeons/statistics & numerical data , Hip Fractures/surgery , Osteoporosis/therapy , Postoperative Care/statistics & numerical data , Chile , Electronic Mail , Femoral Neck Fractures/surgery , Time-to-Treatment , Fracture Fixation, InternalABSTRACT
The number of osteoporotic fractures is increasing along with population aging. Most patients with these type of fractures are older than 65 years, with multiple chronic conditions and different degrees of disability. Hip fracture is the most relevant osteoporotic fracture due to its frequency, costs, severity and complications. Multidisciplinary management is of the utmost importance to obtain good therapeutic results. We herein review the management of this fracture. Orthogeriatric joint management should be incorporated in fragility fracture treatment. We contribute with general recommendations for the perioperative management, which can be homologated for the management of older patients with other type of fragility fractures.
Subject(s)
Humans , Perioperative Care , Osteoporotic Fractures/surgery , Hip Fractures/surgery , Postoperative Period , Antipsychotic Agents/therapeutic use , Delirium/etiology , Delirium/drug therapy , Osteoporotic Fractures/complications , Osteoporotic Fractures/mortality , Hip Fractures/complications , Hip Fractures/mortalityABSTRACT
Background: Vitamin D deficiency is a common condition affecting 40-100% of geriatric population. Aim: To determine the prevalence of vitamin D insufficiency and deficiency in geriatric population surgically treated for hip fracture. Patients and Methods: Analysis of a database of patients aged over 60 years operated for a low energy hip fracture in a three years period. Vitamin D was measured in identified patients, using a blood sample obtained on admission to the hospital. A logistic regression was carried out to evaluate age, gender, morbidity index and season as predictors of vitamin D deficiency. Results: Two hundred and twenty-eight patients aged 84 ± 7 years (82% females), were included in the analysis. One hundred eighty-three patients (80%) presented vitamin D levels below 20 ng/dl (deficiency) and 39 patients (18%) presented with levels between 20 and 30 ng/dl (insufficiency), totaling 98% of patients with hypovitaminosis D. Vitamin D deficiency was especially common among patients with higher American Society of Anesthesiologists (ASA) Physical Status Classification System and during winter-spring period. A negative correlation between age and the proportion of subjects with vitamin D deficiency was found. There was no relation between gender and vitamin D levels. Conclusions: Vitamin D deficiency is especially prevalent in older subjects with hip fracture, reaching 98% in the studied population.