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Fatores associados a internamento hospitalar prolongado em doentes idosos operados a fratura da extremidade proximal do fémur no Serviço de Ortopedia do CHULN-HSM
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Introdução: A osteoporose é a doença óssea mais comum, associada à idade avançada. A manifestação clínica mais relevante é a fratura de fragilidade. Destas, a fratura da extremidade proximal do fémur assume-se como um problema de saúde pública, necessitando comummente de intervenção cirúrgica e internamento hospitalar. A duração deste internamento tem sido estudada, faltando clarificar os fatores que condicionam o seu prolongamento. Objetivos: Identificar fatores associados a internamento prolongado, caracterizando a população idosa operada a fraturas da extremidade proximal do fémur no HSM-CHULN em 2020. Metodologia: Estudo retrospetivo, transversal e observacional, realizado através da análise dos processos clínicos dos doentes idosos operados a fratura da extremidade proximal do fémur em 2020 no Serviço de Ortopedia do HSM-CHULN. A análise estatística foi executada através do programa SPSS, com valor de erro máximo definido como aceitável de 5% (p-value de 0,05). Resultados: A necessidade de transfusão (p-value de 0,018) e um ASA de IV (p-value de 0,017) foram associados de forma estatisticamente significativa com um internamento prolongado (superior a sete dias). Doentes com doença renal crónica (p-value de 0,07), doença cardíaca (p-value de 0,073) ou síndrome demencial (p-value de 0,125) mostraram maior tendência para um internamento prolongado, ainda que sem significância estatística. As restantes variáveis estudadas não se associaram com um internamento prolongado. Discussão/Conclusão: Doentes com várias comorbilidades, sobretudo ASA IV ou anemia peri-operatória com necessidade transfusional, correlacionaram-se com internamentos prolongados. Ter doença renal crónica, doença cardíaca ou síndrome demencial demonstraram uma tendência para mais dias de internamento. Uma abordagem multidisciplinar que permita o rastreio e a compensação eventual das comorbilidades, em articulação com cirurgia precoce, poderá promover uma alta mais rápida. Espera-se que estas conclusões possam contribuir para gerir melhor o risco do doente, a taxa deocupação das enfermarias e as expectativas do doente e da família relativamente ao internamento.
Introduction: Osteoporosis is the most common bone disease and highly associated with aging. Fragility fractures are the most serious event related to osteoporosis. Of these, proximal femur fractures are a real public health problem and commonly require surgical management and hospitalization. The length of stay of this hospitalization has been widely studied, but the factors that lead to prolonged admissions remain unclear. Objectives: Identify factors associated with a prolonged length of stay by characterizing the population that underwent proximal femur fracture surgery at HSM-CHULN during 2020. Methods: Retrospective, transversal and observational study that analyzed data from clinical records of elderly patients that underwent proximal femur fracture surgery during 2020 at HSM-CHULN. Statistics analysis was performed using SPSS and significance was defined at 5% (p-value 0,05). Results: Blood transfusion (p-value 0,018) and ASA score IV (p-value 0,017) were significantly associated with a prolonged length of stay (more than seven days). Patients with chronic kidney disease (p-value 0,07), heart disease (p-value 0,073) or dementia (pvalue 0,125) showed a tendency towards a prolonged length of stay, although not significantly. The remaining studied variables showed no association with a prolonged length of stay. Discussion/Conclusion: Patients with multiple comorbidities, mainly ASA score IV or perioperative anemia that required blood transfusion, were associated with a prolonged length of stay. Patients with chronic kidney disease, heart disease and dementia showed a tendency towards a prolonged length of stay. A multidisciplinary approach that screens patients at risk of prolonged length of stay and stabilizes eventual comorbidities, together with a precocious surgery, may contribute to an earlier discharge. We hope that these conclusions may improve patient risk management, ward occupancy rate and patient and families’ expectations regarding hospitalization.
Introduction: Osteoporosis is the most common bone disease and highly associated with aging. Fragility fractures are the most serious event related to osteoporosis. Of these, proximal femur fractures are a real public health problem and commonly require surgical management and hospitalization. The length of stay of this hospitalization has been widely studied, but the factors that lead to prolonged admissions remain unclear. Objectives: Identify factors associated with a prolonged length of stay by characterizing the population that underwent proximal femur fracture surgery at HSM-CHULN during 2020. Methods: Retrospective, transversal and observational study that analyzed data from clinical records of elderly patients that underwent proximal femur fracture surgery during 2020 at HSM-CHULN. Statistics analysis was performed using SPSS and significance was defined at 5% (p-value 0,05). Results: Blood transfusion (p-value 0,018) and ASA score IV (p-value 0,017) were significantly associated with a prolonged length of stay (more than seven days). Patients with chronic kidney disease (p-value 0,07), heart disease (p-value 0,073) or dementia (pvalue 0,125) showed a tendency towards a prolonged length of stay, although not significantly. The remaining studied variables showed no association with a prolonged length of stay. Discussion/Conclusion: Patients with multiple comorbidities, mainly ASA score IV or perioperative anemia that required blood transfusion, were associated with a prolonged length of stay. Patients with chronic kidney disease, heart disease and dementia showed a tendency towards a prolonged length of stay. A multidisciplinary approach that screens patients at risk of prolonged length of stay and stabilizes eventual comorbidities, together with a precocious surgery, may contribute to an earlier discharge. We hope that these conclusions may improve patient risk management, ward occupancy rate and patient and families’ expectations regarding hospitalization.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2021
Palavras-chave
Osteoporose Fratura de fragilidade Extremidade proximal do fémur Internamento prolongado Ortopedia