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.

Nivel de adecuación de los recursos geriátricos en los hospitales generales españoles: período 2003-2005 / Level of education of geriatric resources in general hospitals in Spain: period 2003 to 2005

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