The impact of prefracture and hip fracture characteristics on mortality in older persons in Brazil.
BACKGROUND
Hip fractures in the elderly are common and associated with considerable mortality and disability. Although well known in industrialized countries, the factors associated with mortality after hip fractures are not reported frequently in developing countries and little is known regarding risk factors in Latin America.


OBJECTIVE
We investigated the rate of 1-year mortality and prefracture and fracture characteristics associated with mortality after a hip fracture in elderly Brazilian patients in a large metropolitan area.


METHODS
Two hundred forty-six persons 60 years and older admitted to four hospitals in Rio de Janeiro were included after experiencing fractures and were followed for 1 year. Data were collected on sociodemographic, health, and functional status; type of surgery; length of stay; and complications after surgery. Cox regression analyses were conducted to investigate factors associated with 1-year mortality after hip fracture.


RESULTS
Of the 246 patients, 86 died (35%). Of those 86, 22 died in the hospital (25.6%) and 64 (74.4%) died after discharge. Functional status before fracture, older age, male gender, and higher surgical risk increased the risk of mortality, whereas the use of antibiotics and the use of physical therapy after surgery decreased the risk.


CONCLUSIONS
Our mortality rate was higher than those reported from industrialized countries. The use of antibiotics and physical therapy are potentially modifiable factors to improve patients' survival after fracture in Brazil.


METHODS
Level II, prognostic study. See the Guidelines for Authors for a complete description of the levels of evidence.
Pereira
Silvia R M
SR
Academic Hospital São Francisco de Assis, Federal University of Rio de Janeiro, Rua Gilberto Cardoso 260/703-Leblon, Rio de Janeiro, RJ, 22430-070, Brazil. silviapereira.geriatra@yahoo.com.br
Puts
Martine T E
MT
Portela
Margareth C
MC
Sayeg
Mario A
MA
D000058:Accidental Falls; D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil / Q000453:epidemiology; D002423:Cause of Death; D015897:Comorbidity; D005260:Female; D006304:Health Status; D006620:Hip Fractures / Q000401:mortality*; D006773:Hospitals, Municipal; D006801:Humans; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000401:mortality*; D011183:Postoperative Complications; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D020127:Recovery of Function; D012307:Risk Factors; D015996:Survival Rate