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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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          Is operative delay associated with increased mortality of hip fracture patients? Systematic review, meta-analysis, and meta-regression.

          Toshiya Shiga, Zen'ichiro Wajima, Yoko Ohe (2008)
          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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            Medical complications and outcomes after hip fracture repair.

            L. Carson, Roy Poses, H Noveck … (2002)
            Most evidence guiding perioperative medical risk management of patients undergoing hip fracture repair focuses on cardiac and thromboembolic risk. Little is known of the relative clinical importance of other complications. To systematically map incidence and outcomes of a broad spectrum of medical complications after hip fracture repair. Retrospective cohort study of patients 60 years or older in 20 academic, community, and Veterans Affairs hospitals. Data on complications and mortality were abstracted from medical records by trained abstractors using standardized, pretested forms or the National Death Index. Of 8930 patients, 1737 (19%) had postoperative medical complications. Cardiac and pulmonary complications were most frequent (8% and 4% of patients, respectively). Similar numbers of patients had serious cardiac or pulmonary complications (2% and 3%, respectively). Other complications were gastrointestinal tract bleeding (2%), combined cardiopulmonary complications (1%), venous thromboembolism (1%), and transient ischemic attack or stroke (1%). Renal failure and septic shock were rare. After the index complication, 416 patients had 587 additional complications. Mortality was similar for serious cardiac or pulmonary complications (30 day: 22% and 17%, respectively; 1 year: 36% and 44%, respectively) and highest for patients with multiple complications (30 day: 29%-38%; 1 year: 43%-62%). Complications and death occurred significantly earlier for serious cardiac than for serious pulmonary complications (1 vs 4 days, 2 vs 8 days, P<.001); length of stay for patients surviving these complications was similar. Most patients had no medical complications after hip fracture repair. Serious cardiac and pulmonary complications were equally important in frequency, mortality, and survivors' length of stay. Patients with multiple complications had especially poor prognosis.
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              ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery) developed in collaboration with the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, and Society for Vascular Surgery.

              Lee A Fleisher, Joshua A Beckman, Kenneth Brown … (2007)
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                Author and article information

                Journal
                Journal ID (nlm-ta): Rev Bras Ortop (Sao Paulo)
                Journal ID (iso-abbrev): Rev Bras Ortop (Sao Paulo)
                Journal ID (doi): 10.1055/s-00042410
                Title: Revista Brasileira de Ortopedia
                Publisher: Sociedade Brasileira de Ortopedia e Traumatologia. Published by Thieme Revnter Publicações Ltda (Rio de Janeiro, Brazil )
                ISSN (Print): 0102-3616
                ISSN (Electronic): 1982-4378
                Publication date (Print): July 2019
                Publication date (Electronic): 20 August 2019
                Volume: 54
                Issue: 4
                Pages: 387-391
                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
                Author information
                http://orcid.org/0000-0002-7144-3170
                Article
                Publisher ID: 170314pt
                DOI: 10.1055/s-0039-1694020
                PMC ID: 6701968
                SO-VID: 108bc435-2acc-4863-931d-dc6b76e5ca88
                License:

                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.

                History
                Date received : 06 September 2017
                Date accepted : 07 December 2017
                Categories
                Subject: Artigo Original | Original Article

                Keywords: femoral fractures/etiology,femoral fractures/surgery,femoral fractures/mortality,postoperative complications,fraturas do fêmur/etiologia,fraturas do fêmur/cirurgia,fraturas do fêmur/mortalidade,complicações pós-operatórias
                Data availability:
                Keywords: femoral fractures/etiology, femoral fractures/surgery, femoral fractures/mortality, postoperative complications, fraturas do fêmur/etiologia, fraturas do fêmur/cirurgia, fraturas do fêmur/mortalidade, complicações pós-operatórias

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