Early rehospitalization after hip fracture in elderly patients: risk factors and prognosis.

INTRODUCTION: Hip fracture usually occurs in older patients. These patients remain at risk for developing new medical complications even after discharge from the hospital. The objective of this study was to identify risk factors for hospital readmission 30 days after hip fracture and the prognosis of the readmitted patients. MATERIALS METHODS: A prospective, observational cohort study of 732 consecutive patients over 65 years surgically treated for hip fracture and discharged alive in 2010-2014 was conducted. The measurements were patient demographic characteristics, residential and discharge status, Katz Index, Merle D'aubigné Hip Score, Mini-Mental Test, comorbid conditions, Charlson Index, ASA group, type of fracture and repair, and postoperative complications. Patient characteristics were tested by bivariate and multivariate analyses. RESULTS: 8.3 % of patients were readmitted within 30 days (56.0 % of these within 2 weeks). Medical reasons were 13 times more frequent than surgical reasons. Diagnoses more prevalent for readmission were pulmonary disease, deep vein thrombosis, heart failure, and renal failure. Predictors of readmission were female gender (HR 1.9, 95 % CI 1.1-3.4), grade III-IV ASA (HR 2.1, 95 % CI 1.1-4.2), and pre-existing pulmonary disease (HR 5.3, 95 % CI 3.4-9.6). In-hospital mortality among readmitted patients was 22.9 %. In bivariate analyses, male gender, ASA III-IV, cognitive impairment, and more than two comorbidities were potential predictive factors for readmission, and in multivariate analysis only male gender and ASA III-IV. Mortality risk among readmitted patients was significantly higher compared to the in-hospital mortality in the overall cohort (OR 1.8, 95 % CI 1.5-2.3). CONCLUSIONS: Hospital readmissions after hip fracture were mainly due to medical complications and a fraction of these may be preventable. Readmission was associated with increased morbidity and mortality.

Componente acetabular no cementado en coxartrosis por fractura de cotilo / Cementless acetabular component in coxarthrosis due to a acetabular fracture

Objetivo. Valoración del componente acetabular no cementado en prótesis total de cadera por artrosis secundaria a fractura de cotilo. Material y método. Estudio prospectivo de 24 pacientes con edad media de 56 años (rango: 28-77) y seguimiento medio de 8,4 años (rango: 5-15), que fueron tratados con acetábulo no cementado atornillado. El tiempo medio entre la fractura y la prótesis fue de tres años (rango: 5 meses-14 años). La fractura había sido tratada conservadoramente en 15 casos y con fijación interna en 9 casos. Se realizó valoración clínica con la escala de Harris y radiográfica, con especial interés en el acetábulo. Resultados. La escala de Harris media se incrementó de 35 puntos (rango: 22-52) a 77 (rango: 45-94). Hubo tres aflojamientos de cotilo, dos con osteólisis que fueron revisados y uno con radiolucencia continua. El vástago femoral precisó revisión quirúrgica en un caso. Hubo un caso de infección profunda y una luxación tardía postraumática. La función de supervivencia de la artroplastia por cualquier causa a 12 años fue del 78,4%. Discusión y conclusiones. Son escasos los estudios al respecto y todos con pequeño número de casos. La tasa de fallos acetabulares es superior que la tasa en los casos no traumáticos. La prótesis no cementada es un tratamiento adecuado para las secuelas de fractura de cotilo (AU)

Objective. To evaluate the outcomes of cementless acetabular component for post-traumatic arthritis after acetabular fracture. Material and method. A prospective study of twenty-four patients with a mean age of 56years (range: 28-77) and a follow-up 8.4years (range: 5-15) treated with cementless total hip arthroplasty. The time from fracture to total hip arthroplasty was 3years (range: 5 months-14years). The fracture had been treated conservatively in 15 cases and with internal fixation in 9 cases. A clinical assessment was made using with Harris hip score, along with radiology with special interest in the socket. Results. Harris hip score increased from 35 points (range: 22-52) to 77 (range: 45-94). Unstable acetabular fixation was seen in 3 cases, 2 with osteolysis that required revision and 1 with a complete radiolucent line. The stem required revision in 1 case. There was 1 case of deep infection and 1 post-traumatic late dislocation. Survival for any cause at 12years was 78.4%. Discussion and conclusions. There are few studies on this topic, and all with a small number of cases. Acetabular failure rate is higher than routine total hip arthroplasty for non-traumatic osteoarthritis. Cementless total hip arthroplasty is a suitable treatment for post-traumatic arthritis after acetabular fracture (AU)