Fractura de cadera en el paciente mayor de 90 años: nuestro nuevo desafío / Hip fracture in the extremely elderly: our new dilemma

INTRODUCCIÓN: El envejecimiento mundial de la población ha resultado en un aumento de las fracturas de cadera y sobre todo en pacientes cada vez más añosos. El objetivo es buscar la mortalidad al año y factores asociados en nuestra realidad nacional. MATERIALES Y MÉTODOS: Estudio retrospectivo observacional de fichas clínicas e imagenología de pacientes mayores de 90 años operados por fractura de cadera en la capital de nuestro país. Se presentan dos grupos según su sistema previsional, pacientes pertenecientes al sistema de salud público (SSPu) y pertenecientes a un sistema de salud privado (SSPr). Se realiza análisis estadístico univariado y multivariado con test de Chi2, Mann-Whitney y regresión logística. RESULTADOS: 129 pacientes mayores de 90 años operados por fractura de cadera (85 pertenecientes al SSPu y 44 en el SSPr), cumplieron con criterios de inclusión y exclusión en un período de 2 años. El promedio de edad general fue de 93,2 años (SD 2,9) sin diferencia entre grupos. El tiempo preoperatorio fue significativamente menor en el SSPr con mediana de 1 día (0­7) y de 6 días (1­40) para el SSPu (p < 0,001). La mortalidad general al año fue de 30,2% siendo de 38,8% para el SSPu y de 13,6% para el SSPr con diferencia significativa (p = 0,003). No se encontró asociación estadística en la mortalidad al año con las variables edad, género ni tipo de fractura. Se encontró asociación entre la mortalidad al año y menor tiempo preoperatorio (p < 0,001). En el análisis multivariado de mortalidad el único factor protector fue pertenecer al SSPr (p = 0,010). DISCUSIÓN: La mortalidad general de nuestros pacientes es similar a lo encontrado en la literatura internacional, siendo el menor tiempo preoperatorio y pertenecer al sistema de salud privado factores asociados a menor mortalidad al año, donde ese último es el único factor asociado en el estudio multivariable. Este estudio aporta a la contingencia nacional en describir cómo se comporta nuestra población tanto en el sistema de salud privado como en el público. Es necesario estudiar el efecto en la mortalidad de otros factores asociados que no fueron evaluados en el presente trabajo.

INTRODUCTION: The aging of world population has resulted in an increase of hip fractures and especially in extremely elderly patients. The objective is to describe 1-year mortality in these patients in our national reality. MATERIALS AND METHODS: Observational retrospective study of clinical records and imaging of patients over 90 years old who were operated for hip fracture in the capital of our country, belonging one group to private care health system (SSPr) and the other group to the public health system (SSPu). Statistical analysis was performed to type of implant and mortality. RESULTS: 129 patients over 90 years old were operated for hip fracture (85 in the SSPu and 44 in the SSPr) in a period of 2 years. The average age was of 93.2 years (SD 2.9) without statistical difference between groups. Preoperative time was significantly lower in SSPr group with mean of 1 day (0­7) for the SSPr and 6 days (1­40) for the SSPu (p < 0,001). The overall 1-year mortality was 30.2%; 38.8% in the SSPu and 13.6%%, which was statistically relevant (p = 0,003). No association was found between 1-year mortality and age, sex or fracture type. Statistical association was found between preoperative time and 1-year mortality where patients who have lower preoperative time have lower 1-year mortality (p < 0,001). Association was found between lower 1-year mortality and belonging to SSPr. This last association was the only one with statistical relevance in the multivariable analysis (p = 0,010) DISCUSSION: Surgery for hip fractures in extremely elderly patients is an increasing reality in our country. The overall mortality of our patients is similar to that published in the international literature, where belonging to private care health system and having a low preoperative time is associated with a lower 1-year mortality in our study. This study contributes to the national contingency in the sense of how our population develops in the private sphere as well as in the public care. It is necessary to study the effect on mortality of other associated factors that were not evaluated in the present study.

Results of surgical treatment of colorectal cancer in nonagenarian patients / Resultados do tratamento cirúrgico do câncer colorretal em pacientes nonagenários

ABSTRACT Purpose: The objective of the present study was to compare the results of surgical treatment of nonagenarian patients having colorectal cancer with patients younger than 90 years. Methods: A total of 622 patients who underwent curative surgery were included in the present study. The database of the surgical service, in the period from 2007 to 2013, was used to obtain the sample. This is a descriptive, retrospective study that compared the profiles of 17 nonagenarian patients (Group I) with 605 patients younger than 90 years (Group II). The groups were compared regarding surgical complications, length of hospital stay, type of surgery performed and ASA classification. Results: The mean age between the groups was 92.2 years and 61.2 years. The mean length of hospital stay in Groups I and II was 17.3 days and 8.75 days, respectively. The surgery performed most frequently was the right colectomy, in both groups. The most common postoperative complication was sepsis (11.8%) among the nonagenarians, and paralytic ileus (4.5%) among those younger than 90 years. Laparoscopic surgery was performed on 5 out of a total of 17 patients evaluated in Group I. Among the three mortalities registered in this latter group, two were classified as ASA III and only one as ASA I. Conclusion: The results indicate that colorectal surgery may be performed in this group, with acceptable morbidity and mortality rates, in patients with low preoperative risk (ASA I/II).

RESUMO Finalidade: O objetivo do presente estudo foi comparar os resultados do tratamento cirúrgico de pacientes nonagenários portadores de câncer colorretal versus pacientes com menos de 90 anos. Métodos: O estudo envolveu 622 pacientes que foram submetidos à cirurgia curativa. Para obtenção da amostra, utilizamos o banco de dados do serviço de cirurgia, abrangendo o período de 2007-2013. Este é um estudo retrospectivo descritivo que comparou os perfis de 17 pacientes nonagenários (Grupo I) versus 605 pacientes com menos de 90 anos (Grupo II). Os grupos foram comparados para complicações cirúrgicas, duração da permanência no hospital, tipo de cirurgia realizada e classificação ASA. Resultados: A média de idade para os Grupos I e II foi, respectivamente, 92,2 e 61,2 anos. A duração média de permanência no hospital nos Grupos I e II foi, respectivamente, 17,3 dias e 8,75 dias. A cirurgia mais frequentemente realizada foi colectomia direita, nos dois grupos. A complicação pós-operatória mais comum foi sepse (11,8%) entre os nonagenários, e íleo paralítico (4.5%) entre os pacientes com menos de 90 anos. Cirurgia laparoscópica foi realizada em 5 pacientes, em um total de 17 pacientes avaliados no Grupo I. Considerando as três mortalidades registradas nesse último grupo, duas foram classificadas como ASA III e apenas uma como ASA I. Conclusão: Os resultados obtidos indicam que, nesse grupo, a cirurgia colorretal é opção válida, com percentuais aceitáveis de morbidade e mortalidade, em pacientes com baixo risco pré-operatório (ASA I/II).