Mortalité à 30 jours après fracture de la hanche ou du bassin. Facteurs prédictifs - 20/09/16
Predictors of 30-day mortality following hip/pelvis fractures
Abstract |
Introduction |
With the cost of healthcare in the United States reaching $2.9 trillion in 2013 and expected to increase with a growing geriatric population, the Center for Medicare and Medicaid Services (CMS) and Hospital Quality Alliance (HQA) began publicly reporting 30-day mortality rates so that hospitals and physicians may begin to confront clinical problems and promote high-quality and patient–centered care. Though the 30-day mortality is considered a highly effective tool in measuring hospital performance, little data actually exists that explores the rate and risk factors for trauma-related hip and pelvis fractures. Therefore, in this study, we sought to explore the risk factors associated with 30-day mortality in trauma-related hip and pelvic fractures.
Materials and methods |
Utilizing the ACS-NSQIP (American College of Surgeons National Surgical Quality Improvement Program) database, 341,062 patients undergoing orthopaedic procedures from 2005 to 2013 were identified through a Current Procedural Terminology (CPT) code search. A second CPT code search identified 24,805 patients who sustained a hip/pelvis fracture. Patient demographics, preoperative comorbidities, operative characteristics and postoperative complications were collected and compared using χ2 test, Wilcoxon-Mann-Whitney test and multivariate logistic regression analysis.
Results |
Preoperative and postoperative risk factors for 30-day mortality following a hip/pelvis fracture were found: ASA classification, ascites, disseminated cancer, dyspnea, functional status, history of congestive heart failure (CHF), history of chronic obstructive pulmonary disease (COPD), a recent blood transfusion, and the postoperative complications: pneumonia, myocardial infarction, stroke, and septic shock.
Discussion |
Several preoperative patient risk factors and postoperative complications greatly increased the odds for patient mortality following 30-days after initial surgery. Orthopaedic surgeons can utilize these predictive risk factors to better improve patient care.
Level of evidence |
Retrospective study. Level IV.
Le texte complet de cet article est disponible en PDF.Keywords : 30-day mortality, Complications, Risk factors, Hip, Pelvis
☆ | Cet article peut être consulté in extenso dans la version anglaise de la revue Orthopaedics & Traumatology: Surgery & Research sur Science Direct (sciencedirect.com) en utilisant le DOI ci-dessus. |
Vol 102 - N° 6
P. 522 - octobre 2016 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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