Factores determinantes de mortalidad, deterioro cognitivo, recuperación de la independencia y capacidad de marcha previas, a los seis meses de padecer fractura de cadera en personas de 65 años o más, en un hospital español

Abstract

Osteoporotic hip fracture is an event with a high and growing incidence worldwide. In Spain, more than 50,000 fractures occur in the elderly and due to low energy per year, 75% women who always require hospitalization, 95% surgical intervention, with a mean hospital stay of 10.9 SD = 6.9 days. They are of great importance in terms of mortality, which is 2-7% on admission, 7.1% in 30 days and 30% per year, and among the factors that increase it, the greatest agreement is in waiting longer for surgery more than 48 hours. The percentage of elderly people with hip fracture who do not recover their previous function ranges between 23 and 50%, depending on several factors, including complications such as delirium, which is more frequent in people with previous cognitive impairment. The highest mortality moment, functional and mental deterioration occurs at the sixth month. In our country, the average cost for this process is 9000 euros. In order to know what mortality and dysfunction at the sixth month, and to what factors are associated, in hip fracture patients aged 65 years or older, treated at our Hospital, a retrospective longitudinal study of 665 patients was carried out, recording sociodemographic characteristics, comorbidities at admission , complications during the same, drugs on admission and discharge, cognitive impairment, assessment of dependence and walking ability on admission, discharge and sixth month; as well as mortality. We have performed both a bivariate and multivariate analysis between all the variables that can influence mortality, cognitive impairment, and the lack of recovery of gait and independence prior to admission at the sixth month of the hip fracture. In addition, a predictive model has been implemented using multiple linear regression that identifies the factors that explain the mental (number of errors in the SPMSQ) and physical dysfunction: quantitative values of the BI (0-100) and FAC (0-5) at the sixth month. The main factors associated with higher mortality are greater dependency, poorer gait and cognitive impairment, institutionalization, polycomorbidity on admission, admission drugs such as anticoagulants and bronchodilators, and complications during admission such as acute heart failure and respiratory infection. Delirium is identified on bivariate analysis but not multivariable adjustment. The factors that explain moderate and severe cognitive impairment at the sixth month are dependency especially prior to admission, cognitive impairment during admission, poor walking at hospital discharge, and institutionalization, all of them more than advanced age. According to the predictive model, the initial deterioration is what fundamentally determines what the patient has at the sixth month (ΔR2=83.2% of the variance PE to 6th month), intervening minimally with the other factors mentioned. Regarding the lack of functional recovery, both of walking and previous independence, the most important factor is the qualitative loss of both functions during admission. Factors with less intensity of effect on this lack recovery of functions are surgical risk, prior cognitive impairment, and advanced age. Hemoglobinemia < 8.5 mg/dl during admission is associated with the lack of global functional recovery, and the extra-articular type of fracture, the non-recovery of walking.