Predictors of hip fracture mortality at a general hospital in South Brazil: an unacceptable surgical delay.
OBJECTIVE
Hip fractures have been associated with increased mortality in the elderly. Several risk factors such as the time between the insult and the surgical repair have been associated with hip fracture mortality. Nevertheless, the risk of delayed surgical repair remains controversial. Few studies have examined this issue in Brazil. The aim of this study was to study the risk factors for death one year after hip fracture and in-hospital stay at a tertiary hospital in South Brazil.


METHODS
A prospective cohort study was carried out from April 2005 to April 2011 at a tertiary university hospital at Santa Maria, Brazil. Subjects admitted for hip fracture who were 65 years of age or older were followed for one year. Information about fracture type, age, gender, clinical comorbidities, time to surgery, discharge, and American Society of Anesthesiologists score were recorded. Death was evaluated during the hospital stay and at one year.


RESULTS
Four hundred and eighteen subjects were included in the final analysis. Of these, 4.3% died in-hospital and 15.3% were dead at one year. Time to surgery, American Society of Anesthesiologists score, Ischemic Heart Disease, and in-hospital stay were associated with death at one year in the univariate analysis. The American Society of Anesthesiologists score and time to surgery were one-year mortality predictors in the final regression model. In-hospital death was associated with American Society of Anesthesiologists score and age.


CONCLUSIONS
Time to surgery is worryingly high at the South Brazil tertiary public health center studied here. Surgical delay is a risk factor that has the potential to be modified to improve mortality.
Centro de Ciências da Saúde (CCS), Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal de Santa Maria (UFSM), Santa Maria, RS, Brazil.
Tiango Aguiar
TA
Ribeiro
Centro de Ciências da Saúde (CCS), Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal de Santa Maria (UFSM), Santa Maria, RS, Brazil.
Melissa Orlandin
MO
Premaor
Serviço de Ortopedia e Traumatologia do Hospital Universitário de Santa Maria (SOT - HUSM), Universidade Federal de Santa Maria (UFSM), Santa Maria, RS, Brazil.
João Alberto
JA
Larangeira
Serviço de Ortopedia e Traumatologia do Hospital Universitário de Santa Maria (SOT - HUSM), Universidade Federal de Santa Maria (UFSM), Santa Maria, RS, Brazil.
Luiz Giulian
LG
Brito
Centro de Ciências da Saúde (CCS), Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal de Santa Maria (UFSM), Santa Maria, RS, Brazil.
Michel
M
Luft
Serviço de Ortopedia e Traumatologia do Hospital Universitário de Santa Maria (SOT - HUSM), Universidade Federal de Santa Maria (UFSM), Santa Maria, RS, Brazil.
Leonardo Waihrich
LW
Guterres
Departamento de Medicina Interna, Serviço de Reumatologia do Hospital de Clínicas de Porto Alegre (HCPA), Faculdade de Medicina (FAMED), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
Odirlei André
OA
Monticielo
D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil; D015897:Comorbidity; D005260:Female; D006620:Hip Fractures / Q000401:mortality* / Q000601:surgery*; D017052:Hospital Mortality; D006769:Hospitals, General; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers; D061665:Time-to-Treatment / Q000706:statistics & numerical data*