Estudio comparativo aleatorizado de la intervención quirúrgica temprana frente a la demorada en los pacientes con fractura de cadera tratados con antiagregantes plaquetarios. Determinación de la agregabilidad plaquetaria y el sangrado perioperatorio, y la revisión de la mortalidad al año / Randomised comparative study of early versus delayed surgery in hip-fracture patients on concomitant treatment with antiplatelet drugs. Determination of platelet aggregation, perioperative bleeding and a review of annual mortality

Revisar el tratamiento perioperatorio de los pacientes con fracturas de cadera y tratamiento concomitante con antiagregantes plaquetarios, así como analizar las diferencias de mortalidad al año, y el sangrado perioperatorio según la pauta de cirugía precoz (< 48 h) vs. demorada (> 5 días). Paralelamente, determinar al ingreso y en el preoperatorio inmediato la agregabilidad plaquetaria en todos los pacientes incluidos en el estudio. Pacientes y método. Sobre 175 pacientes mayores de 65 años con fractura de cadera de baja energía se aleatorizaron 3 grupos: antiagregados con cirugía precoz, antiagregados con cirugía demorada, y no antiagregados con cirugía precoz; se recogieron prospectivamente los mismos datos clínicos y analíticos para todos ellos. La agregabilidad plaquetaria se determinó mediante un sistema informatizado semicuantitativo basado en la agregometría por impedancia en sangre completa. Resultados. El sangrado, los requerimientos transfusionales y los resultados analíticos no mostraron diferencias estadísticamente significativas entre los grupos. Un 59,8% de los pacientes que no referían tomar antiagregantes se encontraban analíticamente antiagregados al ingreso, mientras que un 13,5% de los que tomaban antiagregantes no se encontraban correctamente antiagregados. El análisis multivariante mostró mayor mortalidad a 12 meses para las variables del índice de Barthel bajo previo a la fractura (OR: 0,9-0,9) y número de transfusiones (OR: 1,1-1,5). La estancia media fue de 4,1 días mayor en el grupo demorado. Conclusión. La pauta de cirugía precoz para los pacientes en tratamiento antiagregante tiene resultados clínicos parecidos a la demorada, pero mejora la eficiencia hospitalaria al reducir la estancia media. La antiagregación farmacológica referida por el paciente resultó poco concordante con la determinación de la agregabilidad(AU)

Objective. A review of the perioperative management of patients with hip fractures and concomitant therapy with antiplatelet agents, and to analyse the differences in mortality and perioperative bleeding in early surgery (<48 h) versus delayed surgery (>5 days). Platelet aggregation was measured on admission and immediately before surgery in all patients included in the study. Patients and methods. A total of 175 patients over 65 years old, with low energy hip fracture were randomised into 3 groups: Patients on antiplatelet therapy undergoing early surgery, patients on antiplatelet therapy undergoing delayed surgery, and patients not on antiplatelet therapy undergoing early surgery. The same clinical and laboratory data were collected prospectively up to 12 months for all the patients. The platelet aggregation was determined by a semi-quantitative computerised system based on impedance aggregometry in whole blood. Results. Bleeding, transfusion requirements and analytical results showed no significant differences between groups. More than half (59.8%) of the patients not taking antiplatelet therapy had normal platelet aggregation on admission, while 13.5% of those taking antiplatelet agents did not. Multivariate analysis showed increased mortality at 12 months for the variables, low Barthel index before hip fracture (OR: 0.9-0.9) and number of transfusions (OR: 1.1-1.5). The average lenth of stay was 4.1 days greater in the delayed surgery group. Conclusion. Early surgery for patients receiving antiplatelet therapy has similar clinical outcomes to the delayed, but improves hospital efficiency by reducing the average length of stay. The antiplatelet drug reported by the patient showed low concordance with the determination of the platelet aggregation(AU)

[Randomised comparative study of early versus delayed surgery in hip-fracture patients on concomitant treatment with antiplatelet drugs. Determination of platelet aggregation, perioperative bleeding and a review of annual mortality]. / Estudio comparativo aleatorizado de la intervención quirúrgica temprana frente a la demorada en los pacientes con fractura de cadera tratados con antiagregantes plaquetarios. Determinación de la agregabilidad plaquetaria y el sangrado perioperatorio, y la revisión de la mortalidad al año.

OBJECTIVE: A review of the perioperative management of patients with hip fractures and concomitant therapy with antiplatelet agents, and to analyse the differences in mortality and perioperative bleeding in early surgery (<48 h) versus delayed surgery (>5 days). Platelet aggregation was measured on admission and immediately before surgery in all patients included in the study PATIENTS AND METHODS: A total of 175 patients over 65 years old, with low energy hip fracture were randomised into 3 groups: Patients on antiplatelet therapy undergoing early surgery, patients on antiplatelet therapy undergoing delayed surgery, and patients not on antiplatelet therapy undergoing early surgery. The same clinical and laboratory data were collected prospectively up to 12 months for all the patients. The platelet aggregation was determined by a semi-quantitative computerised system based on impedance aggregometry in whole blood. RESULTS: Bleeding, transfusion requirements and analytical results showed no significant differences between groups. More than half (59.8%) of the patients not taking antiplatelet therapy had normal platelet aggregation on admission, while 13.5% of those taking antiplatelet agents did not. Multivariate analysis showed increased mortality at 12 months for the variables, low Barthel index before hip fracture (OR: 0.9-0.9) and number of transfusions (OR: 1.1-1.5). The average lenth of stay was 4.1 days greater in the delayed surgery group. CONCLUSION: Early surgery for patients receiving antiplatelet therapy has similar clinical outcomes to the delayed, but improves hospital efficiency by reducing the average length of stay. The antiplatelet drug reported by the patient showed low concordance with the determination of the platelet aggregation.

Calidad de vida en artroplastia de rodilla. Utilidad de la escala RAPT / Quality of life after knee arthroplasty: utility of the RAPT scale

Objetivos. Primero, validar la escala Risk Assessment and Prediction Tool (RAPT) para valorar el tratamiento rehabilitador tras prótesis total de rodilla (PTR) en nuestra población. Y, segundo, utilizando la escala validada, identificar los factores que influyen en la calidad de vida previa y a los 3 meses de la PTR. Método. Estudio prospectivo de todos los pacientes con indicación de PTR ingresados desde enero a julio de 2005 (cohorte 1) y desde enero a julio de 2006 (cohorte 2). Procedimiento de traducción-retrotraducción y validación de la escala RAPT en cohorte 1 (49 pacientes). Se evaluó la calidad de vida mediante EQ-5D y WOMAC. Se realizó un análisis de regresión lineal y logística múltiple en cohorte 2 (106 pacientes) de los factores relacionados con peor calidad de vida. Resultados. La validación de la escala RAPT obtuvo una buena correlación con EQ-5D y WOMAC. En la cohorte 2, los pacientes se clasificaron en 4 grupos según RAPT (medio-alto y bajo) y lugar de residencia (rural y urbano). Un nivel de RAPT medio-alto y vivir en zona rural se relacionó con peor calidad de vida previa y a los 3 meses. En cambio, tener una PTR previa y pareja fueron factores relacionados con mejor calidad de vida previa. Los factores relacionados con peor calidad de vida a los 3 meses fueron ser mujer y la edad avanzada. Conclusiones. La escala RAPT es un instrumento válido, fiable y de fácil aplicación. La escala RAPT y zona de residencia permiten estratificar los pacientes según la calidad de vida y la necesidad de rehabilitación (AU)

Objective. The first objective is to validate the Risk Assessment and Prediction Tool (RAPT) scale to assess rehabilitation therapy after total knee arthroplasty (TKA) in our population. The second objective is to identify the factors that affect quality of life before and at 3 months post-TKA using the validated scale. Method. A prospective study of all patients with TKA admitted to hospital from January to July 2005 (cohort 1) and from January to July 2006 (cohort 2) was performed. The «translation-back-translation» procedure and validation of the RAPT scale in cohort 1 (49 patients) were carried out. Quality of life was assessed with the WOMAC and EQ-5D scales. A lineal regression and multiple logistic analysis was carried out in cohort 2 (106 patients) regarding the factors related to worse quality of life. Results. Validation of the RAPT scale obtained good correlation with the EQ-5D and WOMAC. The cohort 2 patients were classified into 4 groups according RAPT (medium-high and low) and place of residence (rural and urban). Medium-high RAPT level together with rural residence was associated with worse quality of life before and at 3 months post-TKA. Having a previous TKA and living with a partner were factors associated with a better previous quality of life. Older age and female gender were factors associated with worse quality of life at 3 months. Conclusions. The RAPT scale is a valid, reliable, and easy-to-use application. The RAPT scale and area of residence makes it possible to stratify patients according to quality of life and need for rehabilitation (AU)