Pressure ulcer and mortality risk after surgical treatment of proximal femoral fractures in the elderly [Dekubitus a riziko úmrtí seniorů operovaných pro zlomeninu proximálního femuru]

Traumacentrum, Masarykova nemocnice, Ústí nad Labem.
Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca (Impact Factor: 0.42). 01/2011; 78(2):156-60.
Source: PubMed

ABSTRACT We aimed to determine the incidence of pressure sores and their effect on survival in patients older than 70 years who underwent surgery for hip fracture, and to identify the factors which were associated with an increased risk of pressure sores.
The group comprised 269 patients (219 women and 50 men) older than 70 years who underwent surgery for proximal femoral fractures in the Trauma center between January 2003 and June 2005. Follow-up ranged from 12 to 18 months. In a prospective study we assessed relevant medical history, demographic and clinical data, pre-, intra-, and post-operative factors and the presence, location and depth of pressure sores. Statistical significance at a 5 % level of probability was determined by testing null hypotheses for qualitative and quantitative variables, using multivariate analysis adjusted for selected baseline characteristics.
The average age of the patient group was 81 years (range, 70-99). Pressure ulcers developed in 92 patients (34.2 %); their presence in the post-operative period significantly reduced patient survival (p=0.037). In terms of location, pressure ulcers in the calcaneal region had a more significant effect on patient mortality (p=0.011) than those in the sacral region (p=0.130). Age was not significantly associated with pressure ulcer development (p=0.547), in contrast to male gender (p=0.007). A lower mobility score before injury was a significant risk factor (p=0.007). Co-morbidities adjusted for age and gender had a significant effect (p=0.003). The factors that did not significantly increase the risk of pressure ulcers were as follows: the patient's living environment before injury (p=0.113), AO type of fracture (p=0.653), type of anaesthesia (p=0.702), surgical procedure used (p=0.946), morbidity before injury (p=0.267) and time to surgery (p=0.180). The presence of acute complications was of boundary significance (p=0.083). DISCUSSION The study included only the patients with proximal femoral fractures who underwent surgery. It was the authors' view that, by excluding conservatively treated patients, a more homogenous group was achieved. There is only sparse information in the literature concerning the effect of pressure ulcers on reduced patient survival, and the significance of pressure ulcer location has not been evaluated at all. Similarly, the effect of pre-morbidity on pressure ulcer development has not been reported in any of the studies available. In contrast to other studies, the authors did not find age to be a risk factor for increased ulcer development. They believe that the quality and quantity of the input data (prospective data collection, large sample size, long follow-up) guarantee the validity of the results obtained in this study. The incidence of pressure sores is in agreement with the results of relevant studies involving large numbers of patients and prolonged follow-up.
In patients older than 70 years undergoing surgery for hip fracture, the development of pressure ulcers had a significant effect on reduced survival, with the highest significance for ulcers in the calcaneal region. Factors significantly increasing the risk of ulcer development were male gender, morbidity before injury and pre-existing chronic complications. The presence of acute complications was of boundary significance. The study did not show any significant effect of age, pre-morbidities, time to surgery, patient's living environment before injury, fracture type, type of anaesthesia or surgical procedure used on the incidence of pressure ulcers.

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    • "Pressure ulcers (PU) represent a widespread, painful, and expensive health care problem [1] [2] [3] directly associated with increased morbidity, mortality, and length of hospital stay [4] [5] [6] [7]. "
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    ABSTRACT: Pressure ulcers (PU) represent a widespread, painful, and expensive health care problem directly associated with increased morbidity, mortality, and length of hospital stay. The aim of this study was to determine the prevalence of PU in hospitalised patients in public and private Brazilian institutions and the ulcers' associations with nutritional status and other risk factors. A multicenter, cross-sectional, quantitative and qualitative study was carried out in hospitals in different geographic regions of Brazil from March 2009 to February 2011. The prevalence and characteristics of PU, the nutritional status and the association between the presence of PU, and the nutritional status and other study variables were evaluated. The association of the presence of PU with the study variables was performed by univariate analyses and multivariate logistic regression models. The final multivariate model was one in which all variables were significant at the 0.05 level. According to the subjective global assessment (SGA), the prevalence of PU was 16.9%, and 52.4% of patients were malnourished. PU and their severity were directly associated with malnutrition (P < 0.05). Patients who are bedridden, who are elderly, who have neurological disorders or cancer, who are staying at a public or private institution, and who are staying at the hospital between 8 d and 15 d had an increased risk of PU (P < 0.05). The prevalence of PU in Brazilian general hospitals is high, and the prevalence of malnutrition is extremely high. Malnourishment is one of the most important risk factors associated with the development and severity of PU in hospitals. Patients who are malnourished are more prone to developing PU.
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  • International anesthesiology clinics 01/2013; 51(1):128-46. DOI:10.1097/AIA.0b013e31826f2dcd
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    ABSTRACT: Las fracturas del fémur proximal están entre las más frecuentes de la consulta traumatológica. Ocupan el tercer lugar (11,5%) y predominan en el sexo femenino. Clásicamente se trata de una fractura de la persona anciana, puesto que el promedio de edad es de 80 años, mientras que el 97% y el 75% de los pacientes tienen, respectivamente, más de 50 y 79 años. Se las considera un marcador de la osteoporosis. Las fracturas del extremo superior del fémur comprometen el pronóstico vital del anciano y las fracturas del cuello femoral comprometen el pronóstico funcional de la persona joven, exponiéndola al riesgo de desarrollar una osteonecrosis aséptica de la cabeza del fémur. Desde el punto de vista anatómico, el fémur proximal está constituido por la cabeza, el cuello y el macizo trocantéreo que, por definición, se extiende hasta 2,5 cm por debajo del trocánter menor. Este artículo se centra en las fracturas traumáticas recientes de las tres zonas anatómicas, excluidas las fracturas patológicas y las que se producen a partir de un implante. Se considerarán las fracturas del trocánter menor y del trocánter mayor, así como las fracturas por esfuerzo. La sospecha de una fractura del fémur proximal es clínica y los síntomas y signos son típicos: dolor, deformación e impotencia funcional. El diagnóstico se confirma con la evaluación radiológica. La radiografía anteroposterior (AP) de la pelvis es sistemática en el paciente inconsciente y en caso de fractura de la diáfisis femoral. El tratamiento depende de la edad y del tipo de fractura. Abarca desde el tratamiento funcional hasta la prótesis total de la cadera. Después del análisis epidemiológico de estas fracturas, se explicará el protocolo diagnóstico. Además, se exponen y se analizan las diversas clasificaciones de estas fracturas. Por último, se detalla la conducta terapéutica en función de la localización de la fractura.
    09/2014; 47(3):1–19. DOI:10.1016/S1286-935X(14)68514-2
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