Factors Associated with Readmission within 30 Days after Discharge and In-Hospital Mortality after Proximal Femoral Fracture Surgery in the Elderly: Retrospective Cohort

老年人股骨近端骨折手术后出院后 30 天内再入院和住院死亡率的相关因素:回顾性队列研究

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作者:Alex Fabiano Dias Pinto, Clarissa Moreira Teatini, Núbia Carelli Pereira de Avelar, Amanda Aparecida Oliveira Leopoldino, Isabel Cristina Gomes Moura

Abstract

Objective To evaluate the factors associated with readmission within 30 days after discharge (R30) and in-hospital mortality (IHM) in elderly patients undergoing proximal femur fracture surgery (PFF). Methods Retrospective cohort with data from 896 medical records of elderly (≥ 60 years) patients submitted to PFF surgery in a Brazilian hospital between November 2014 and December, 2019. The patients included were followed-up from the date of hospitalization for surgery up to 30 days after discharge. As independent variables, we evaluated gender, age, marital status, pre- and postoperative hemoglobin (Hb), international normalized ratio, time of hospitalization related to the surgery, door-surgery time, comorbidities, previous surgeries, use of medications, and the American Society of Anesthesiologists (ASA) score. Results The incidence of R30 was 10.2% (95% confidence interval [CI]: 8.3-12.3%), and the incidence of IHM was 5.7% (95%CI: 4.3-7.4%). Regarding R30, hypertension (odds ratio [OR]: 1.71; 95%CI: 1.03-2.96), and regular use of psychotropic drugs (OR: 1.74; 95%CI: 1.12-2.72) were associated in the adjusted model. In the case of IHM, higher chances were associated with chronic kidney disease (CKD) (OR: 5.80; 95%CI: 2.64-12.31), longer hospitalization time (OR: 1.06; 95%CI: 1.01-1.10), and R30 (OR: 3.60; 95%CI: 1.54-7.96). Higher preoperative Hb values were associated with a lower chance of mortality (OR: 0.73; 95%CI: 0.61-0.87). Conclusion Findings suggest that the occurrence of these outcomes is associated with comorbidities, medications, and Hb.

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