Factores determinantes de estancia hospitalaria, mortalidad y evolución funcional tras cirugía por fractura de cadera en el anciano / Predictive factors of hospital stay, mortality and functional recovery after surgery for hip fracture in elderly patients

Objetivos. Analizar las características de los pacientes ingresados por fractura de cadera y su evolución 6 meses tras la cirugía para determinar los factores potencialmente relacionados con estancia hospitalaria, complicaciones médicas, mortalidad y recuperación funcional tras esta enfermedad tan prevalente y con graves consecuencias. Material y métodos. Estudio prospectivo de un grupo de 130 pacientes mayores de 75 años hospitalizados por fractura de cadera de perfil osteoporótico. Se evaluaron sus antecedentes médicos, situación mental y física previas a la caída, tipos de fractura y tratamiento quirúrgico, complicaciones hospitalarias, así como evolución funcional y social tras la hospitalización. Resultados. Los pacientes que tenían mayor grado de deterioro físico y mental previamente a la fractura y los institucionalizados tuvieron peor capacidad de recuperación tras la cirugía. El empleo de terapias alternativas a la transfusión para el tratamiento de la anemia se relacionó con disminución de estancia hospitalaria y mejor capacidad de deambulación a medio plazo. Las principales complicaciones médicas en el ingreso fueron infección e insuficiencia cardiaca, e implicaron prolongación de la hospitalización. La prescripción de suplementos nutricionales en pacientes adecuadamente seleccionados se relacionó con mejor evolución funcional. Conclusiones. La valoración de la situación mental, física y social previas a la fractura debe ser la base de un plan de tratamiento individualizado por ser claramente determinante de pronóstico. Los equipos multidisciplinares con seguimiento médico continuado simultáneo al quirúrgico son importantes para prevenir y tratar precozmente las frecuentes complicaciones perioperatorias. La administración de ferroterapia intravenosa y la prescripción de suplementos de nutrición pueden mejorar la recuperación física a medio plazo del paciente intervenido fractura de cadera (AU)

Objectives. Due to its high prevalence and serious consequences it is very important to be well aware of factors that might be related to medical complications, mortality, hospital stay and functional recovery in elderly patients with hip fracture. Material and methods. A prospective study of a group of 130 patients aged over 75 years admitted for osteoporotic hip fracture. Their medical records, physical and cognitive status prior to the fall, fracture type and surgical treatment, medical complications and functional and social evolution after hospitalization were evaluated. Results. Patients with greater physical disability, more severe cognitive impairment and those who lived in a nursing home before the fracture had worse functional recovery after surgery. Treatment with intravenous iron to reduce transfusions reduced hospital stay and improved walking ability. Infections and heart failure were the most frequent medical complications and were related to a longer hospital stay. The prescription of nutritional supplements for the patients with real indication improved their physical recovery after the hip fracture. Conclusions. Evaluation of physical, cognitive and social status prior to hip fracture should be the basis of an individual treatment plan because of its great prognostic value. Multidisciplinary teams with continuous monitoring of medical problems should prevent and treat complications as soon as possible. Intravenous iron and specific nutritional supplements can improve functional recovery six months after hip fracture (AU)

Predictive factors of hospital stay, mortality and functional recovery after surgery for hip fracture in elderly patients. / Factores determinantes de estancia hospitalaria, mortalidad y evolución funcional tras cirugía por fractura de cadera en el anciano.

OBJECTIVES: Due to its high prevalence and serious consequences it is very important to be well aware of factors that might be related to medical complications, mortality, hospital stay and functional recovery in elderly patients with hip fracture. MATERIAL AND METHODS: A prospective study of a group of 130 patients aged over 75 years admitted for osteoporotic hip fracture. Their medical records, physical and cognitive status prior to the fall, fracture type and surgical treatment, medical complications and functional and social evolution after hospitalization were evaluated. RESULTS: Patients with greater physical disability, more severe cognitive impairment and those who lived in a nursing home before the fracture had worse functional recovery after surgery. Treatment with intravenous iron to reduce transfusions reduced hospital stay and improved walking ability. Infections and heart failure were the most frequent medical complications and were related to a longer hospital stay. The prescription of nutritional supplements for the patients with real indication improved their physical recovery after the hip fracture CONCLUSIONS: Evaluation of physical, cognitive and social status prior to hip fracture should be the basis of an individual treatment plan because of its great prognostic value. Multidisciplinary teams with continuous monitoring of medical problems should prevent and treat complications as soon as possible. Intravenous iron and specific nutritional supplements can improve functional recovery six months after hip fracture.

[Clostridium difficile associated diarrhea in the elderly patient]. / Diarrea asociada a Clostridium difficile en el paciente anciano.

Clostridium difficile is the leading cause of infectious nosocomial diarrhea in the elderly. It may cause colitis of variable severity and extraintestinal involvement. Hand transmission is the most important, and it is related to prolonged antibiotic therapies in elderly patients with severe baseline disease. Diagnosis is based on culture and immunological tests to detect its toxins. When there is no response to conservative treatment (withdrawal of the antibiotic and support therapy), metronidazole or vancomycin should be given. Recurrences, up to 20%, are frequent. Preventive measures of its spreading are essential due to the elevated transmission through health care personnel and instruments. Detection of new, more virulent, gene variants of Clostridium difficile have increased the importance of this disease.

Diarrea asociada a Clostridium difficile en el paciente anciano / Clostridium difficile associated diarrhea in the elderly patient

Clostridium difficile es la causa más importante de diarrea infecciosa de transmisión nosocomial en ancianos. Puede producir grados de colitis de intensidad variable y afectación de órganos extraintestinales. Se transmite por vía feco-oral, a veces de forma epidémica en centros sanitarios, y se relaciona con la administración de gran variedad de antibióticos de forma prolongada en pacientes con patología severa de base. El cultivo en medios específicos o la detección de sus toxinas son los métodos habituales de diagnóstico. En caso de no haber respuesta al tratamiento conservador (retirada del antibiótico y terapia de soporte) se administrará metronidazol o vancomicina. Son frecuentes las recurrencias (hasta un 20%). Las medidas preventivas de su diseminación son imprescindibles, por la elevada transmisión a través del personal e instrumental sanitario. La detección de nuevas cepas de mayor virulencia y peor respuesta al tratamiento convencional hace de esta enfermedad nosocomial una entidad de importancia creciente

Clostridium difficile is the leading cause of infectious nosocomial diarrhea in the elderly. It may cause colitis of variable severity and extraintestinal involvement. Hand transmission is the most important, and it is related to prolonged antibiotic therapies in elderly patients with severe baseline disease. Diagnosis is based on culture and immunological tests to detect its toxins. When there is no response to conservative treatment (withdrawal of the antibiotic and support therapy), metronidazole or vancomycin should be given. Recurrences, up to 20%, are frequent. Preventive measures of its spreading are essential due to the elevated transmission through health care personnel and instruments. Detection of new, more virulent, gene variants of Clostridium difficile have increased the importance of this disease

[Groups of resource utilization in acute care units and average length of stay at geriatrics services]. / Grupos de utilizacion de recursos en Unidades de agudos y media estancia de Servicios de Geriatria.

BACKGROUND: In recent years, Patient Classifications Systems (PCS's) have been implement in Spain for the purpose of gauging the "hospital product". However, the most conventional systems are not very well-suited to the senior citizen population, among whom illness-related disability is a determining factor with regard to explaining the usage of resources and the results of the health care provided. Therefore, the idea was brought forth of implementing a system in units providing senior citizen care which would entail this parameter, that is, the Resource Usage Groups (RUG's), analyzing the characteristics and differences in the RUG-related spread in four Geriatrics Units. METHODS: A cross-sectional study based on consecutive cutoff points in periods longer than the average stay in each unit, the patients admitted in the acute care units and average stay in the Geriatrics Unit of the Hospital Monte Narango (HMN) (n = 318), Hospital Central de la Cruz Roja (HCCR) (n = 384), Hospital General de Guadalajara (HG) (n = 272) and Hospital Virgen del Valle (HVV) (n = 390), with regard to the spread thereof according to the RUG-T18 classification. The possible differences among the hospitals in question were analyzed by means of the chi-square statistical test (SPSS for Windows). RESULTS: For the overall sample, the patients were divided into groups R, S and C of the classification, groups P and B being represented to a very small degree, differences having been found to exist among the different hospitals. Hence, the HCCR is that which handles the largest percentage of patients in the R group (47.64% vs. 23.66% at HMN; 20.57% at HG and 20.53% at HVV) and a smaller percentage of patients in the S Group (3.12% vs. 6.40% at HMN; 9.92% at HG and 9.76% at HVV) and the C Group (48.94% vs. 76.29% at HMN; 66.89% at HG and 68.36% at HVV). Differences were likewise found to exist in the individual analysis for the acute care units and average length of stay. CONCLUSIONS: The resource usage groups can be useful with regard to ascertaining differences in the health care loads in hospital care for senior citizens.