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      The Relationship between the Lee Score and Postoperative Mortality in Patients with Proximal Femur Fractures *

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          Abstract

          Objective  To verify the predictive value of the Lee score for mortality in a one-year period after proximal femur fracture surgery. The present study also evaluated the isolated predictive capacity of other variables.

          Methods  A sample of 422 patients with surgically-treated proximal femur fractures was evaluated. Data was collected through a review of medical records, appointments, and contact by telephone.

          Results  The Lee score was applied to 99.3% of the patients with proximal femur fractures submitted to surgical treatment. The mortality rate was of 22% of the sample, and the majority were classified as class I risk. The Lee score had no significant association with mortality ( p  = 0.515). High levels of serum creatinine ( p  = 0.001) and age ( p  = 0.000) were directly associated with death.

          Conclusion  The Lee score was not predictive of mortality in a one-year period after proximal femur fracture surgery; however, a statistical significance was observed between age and serum creatinine levels, considered separately, and death.

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          Most cited references 19

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          Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery.

          Cardiac complications are important causes of morbidity after noncardiac surgery. The purpose of this prospective cohort study was to develop and validate an index for risk of cardiac complications. We studied 4315 patients aged > or = 50 years undergoing elective major noncardiac procedures in a tertiary-care teaching hospital. The main outcome measures were major cardiac complications. Major cardiac complications occurred in 56 (2%) of 2893 patients assigned to the derivation cohort. Six independent predictors of complications were identified and included in a Revised Cardiac Risk Index: high-risk type of surgery, history of ischemic heart disease, history of congestive heart failure, history of cerebrovascular disease, preoperative treatment with insulin, and preoperative serum creatinine >2.0 mg/dL. Rates of major cardiac complication with 0, 1, 2, or > or = 3 of these factors were 0.5%, 1.3%, 4%, and 9%, respectively, in the derivation cohort and 0.4%, 0.9%, 7%, and 11%, respectively, among 1422 patients in the validation cohort. Receiver operating characteristic curve analysis in the validation cohort indicated that the diagnostic performance of the Revised Cardiac Risk Index was superior to other published risk-prediction indexes. In stable patients undergoing nonurgent major noncardiac surgery, this index can identify patients at higher risk for complications. This index may be useful for identification of candidates for further risk stratification with noninvasive technologies or other management strategies, as well as low-risk patients in whom additional evaluation is unlikely to be helpful.
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            Is operative delay associated with increased mortality of hip fracture patients? Systematic review, meta-analysis, and meta-regression.

            Mortality associated with hip fracture is high in elderly patients. Surgical repair within 24 hr after admission is recommended by The Royal College of Physicians' guidelines; however, the effect of operative delay on mortality remains controversial. The objective of this study was to determine whether operative delay increases mortality in elderly patients with hip fracture. Published English-language reports examining the effect of surgical delay on mortality in patients who underwent hip surgery were identified from electronic databases. The primary outcome was defined as all-cause mortality at 30 days and at one year. Effect sizes with corresponding 95% confidence intervals were calculated by using a DerSimonian-Laird randomeffects model. Sixteen prospective or retrospective observational studies (257,367 patients) on surgical timing and mortality in hip fracture patients were selected. When a cut-off of 48 hr from the time of admission was used to define operative delay, the odds ratio for 30-day mortality was 1.41 (95% CI = 1.29-1.54, P < 0.001), and that for one-year mortality was 1.32 (95% CI = 1.21-1.43, P < 0.001). In hip fracture patients, operative delay beyond 48 hr after admission may increase the odds of 30-day all-cause mortality by 41% and of one-year all-cause mortality by 32%. Potential residual confounding factors in observational studies may limit definitive conclusions. Although routine surgery within 48 hr after admission is hard to achieve in most facilities, anesthesiologists must be aware that an undue delay may be harmful to hip fracture patients, especially those at relatively low risk or those who are young.
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              Cardiopulmonary exercise testing as a screening test for perioperative management of major surgery in the elderly.

              To develop an integrated strategy for the identification and subsequent management of high-risk patients in order to reduce both morbidity and mortality. Prospective consecutive series in which all patients underwent cardiopulmonary exercise (CPX) testing. CPX laboratory and level 3 ICU and high-dependency unit (HDU) of a metropolitan teaching hospital. Five hundred forty-eight patients >60 years of age (or younger with known cardiopulmonary disease) scheduled for major intra-abdominal surgery. The patients were assigned to one of three management strategies (ICU, HDU, or ward) based on the anaerobic threshold (deltaT) and ECG evidence of myocardial ischemia as determined by CPX testing that was performed as part of the presurgery evaluation, and by the expected oxygen demand stress of the surgical procedure. Overall mortality was 3.9%. Forty-three percent of deaths were attributed to poor cardiopulmonary function, as detected preoperatively. There were no deaths related to cardiopulmonary complications in any patient deemed fit for major abdominal surgery and ward management, as determined by CPX testing. In elderly patients undergoing major intra-abdominal surgery, the AT, as determined by CPX testing, is an excellent predictor of mortality from cardiopulmonary causes in the postoperative period. Preoperative screening using CPX testing allowed the identification of high-risk patients and the appropriate selection of perioperative management.
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                Author and article information

                Affiliations
                [1 ]Serviço de Ortopedia e Traumatologia, Hospital Universitário de Canoas, Canoas, RS, Brasil
                [2 ]Serviço de Ortopedia e Traumatologia, Universidade Luterana do Brasil (Ulbra), Canoas, RS, Brasil
                Author notes
                Endereço para correspondência Luiz Giglio, MD Serviço de Ortopedia e Traumatologia, Hospital Universitário de Canoas Canoas, RS, 92425-020Brasil lgiglio17@ 123456hotmail.com
                Journal
                Rev Bras Ortop (Sao Paulo)
                Rev Bras Ortop (Sao Paulo)
                10.1055/s-00042410
                Revista Brasileira de Ortopedia
                Sociedade Brasileira de Ortopedia e Traumatologia. Published by Thieme Revnter Publicações Ltda (Rio de Janeiro, Brazil )
                0102-3616
                1982-4378
                July 2019
                20 August 2019
                : 54
                : 4
                : 387-391
                170314pt
                10.1055/s-0039-1694020
                6701968

                This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License, which permits unrestricted reproduction and distribution, for non-commercial purposes only; and use and reproduction, but not distribution, of adapted material for non-commercial purposes only, provided the original work is properly cited.

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                Artigo Original | Original Article

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