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      Impacto de la demencia en la supervivencia de los pacientes con fractura de cadera intervenidos mediante prótesis total y parcial Translated title: Impact of dementia on the survival of patients with hip fracture after undergoing total and partial prosthesis

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          Abstract

          Resumen Objetivo Realizar un análisis de la supervivencia comparativa de los pacientes diagnosticados de fracturas de cadera (FC) en el Servicio Vasco de Salud de 2010 a 2016 en función de que estuviesen o no diagnosticados de demencia y del tipo de artroplastia. Material y métodos Estudio de tipo observacional (real world data) de supervivencia. Los datos fueron obtenidos de las bases de datos administrativas y clínicas del Servicio Vasco de Salud mediante el gestor Oracle Business Intelligence (OBI). Se analizaron todos los casos de fracturas de cuello de fémur desde el año 2010 al 2016 en Servicio Vasco de Salud. Se realizó un análisis descriptivo para detectar diferencias entre grupos según diagnóstico previo de demencia y tipo de prótesis. Para obtener las curvas de supervivencia se utilizó el método de Kaplan?Meier y su comparación se realizó por parejas mediante el logrank test. Mediante la regresión de Cox se analizó el riesgo de fallecimiento ajustado de cada grupo. Resultados Se identificaron 5.867 pacientes con FC, siendo 1.131 pacientes sin demencia y prótesis total, 3.073 sin demencia y prótesis parcial, 176 con demencia y prótesis total y 1.487 con demencia y prótesis parcial. La mediana de la supervivencia fue de 9,08 años, 3,79 años, 2,55 años y 2,54 años respectivamente. La comparación de las curvas de supervivencia resultó significativa para todos los casos excepto entre los dos últimos grupos. Utilizando el primer grupo como referencia, el odds ratio de fallecimiento del resto fue 1,56, 2,27 y 2,37 respectivamente. Al analizar el riesgo de fallecimiento únicamente para los pacientes con demencia, el tipo de prótesis no resultó ser estadísticamente significativo. Conclusiones La demencia influye en la curva de supervivencia de los pacientes que son sometidos a una artroplastia tras una fractura de cuello femoral, teniendo una mortalidad similar los que reciben una artroplastia total que los que se intervienen con una parcial.

          Translated abstract

          Summary Objetive To carry out a comparative survival analysis of patients diagnosed with hip fractures (HF) in the Basque Health Service from 2010 to 2016 depending on whether or not they were diagnosed with dementia and the type of arthroplasty. Material and methods Observational study (real world data) of survival. The data were obtained from the administrative and clinical databases of the Basque Health Service using the Oracle Business Intelligence (OBI) manager. All cases of femur neck fractures from 2010 to 2016 were analyzed in the Basque Health Service. A descriptive analysis was carried out to detect differences between groups according to previous diagnosis of dementia and type of prosthesis. The Kaplan-Meier method was used to obtain the survival curves and their comparison was made in pairs using the Achievement test. The adjusted risk of death for each group was analyzed with the Cox regression model. Results 5,867 patients with CF were identified, being 1,131 patients without dementia and total prosthesis, 3,073 without dementia and partial prosthesis, 176 with dementia and total prosthesis and 1,487 with dementia and partial prosthesis. The median survival was 9.08 years, 3.79 years, 2.55 years, and 2.54 years respectively. The comparison of the survival curves was significant for all cases except between the last two groups. Using the first group as a reference, the odds ratio of death for the rest was 1.56, 2.27 and 2.37 respectively. When analyzing the risk of death only for patients with dementia, the type of prosthesis was not statistically significant. Conclusions Dementia influences the survival curve of patients who undergo arthroplasty after a femur neck fracture, with those who undergo a total arthroplasty have a similar mortality rate as those who undergo partial arthroplasty.

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          Meta-analysis: excess mortality after hip fracture among older women and men.

          Although an increased risk for death after hip fracture is well established, whether this excess mortality persists over time is unclear. To determine the magnitude and duration of excess mortality after hip fracture in older men and women. Electronic search of MEDLINE and EMBASE for English and non-English articles from 1957 to May 2009 and manual search of article references. Prospective cohort studies were selected by 2 independent reviewers. The studies had to assess mortality in women (22 cohorts) or men (17 cohorts) aged 50 years or older with hip fracture, carry out a life-table analysis, and display the survival curves of the hip fracture group and age- and sex-matched control groups. Survival curve data and items relevant to study validity and generalizability were independently extracted by 2 reviewers. Time-to-event meta-analyses showed that the relative hazard for all-cause mortality in the first 3 months after hip fracture was 5.75 (95% CI, 4.94 to 6.67) in women and 7.95 (CI, 6.13 to 10.30) in men. Relative hazards decreased substantially over time but did not return to rates seen in age- and sex-matched control groups. Through use of life-table methods, investigators estimated that white women having a hip fracture at age 80 years have excess annual mortality compared with white women of the same age without a fracture of 8%, 11%, 18%, and 22% at 1, 2, 5, and 10 years after injury, respectively. Men with a hip fracture at age 80 years have excess annual mortality of 18%, 22%, 26%, and 20% at 1, 2, 5, and 10 years after injury, respectively. Cohort studies varied, sometimes markedly, in size, duration of observation, selection of control populations, ascertainment of death, and adjustment for comorbid conditions. Only published data that displayed findings with survival curves were examined. Publication bias was possible. Older adults have a 5- to 8-fold increased risk for all-cause mortality during the first 3 months after hip fracture. Excess annual mortality persists over time for both women and men, but at any given age, excess annual mortality after hip fracture is higher in men than in women. Fund for Scientific Research and Willy Gepts Foundation, Universitair Ziekenhuis Brussel.
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            Incidence and Prediction of Falls in Dementia: A Prospective Study in Older People

            Background Falls are a major cause of morbidity and mortality in dementia, but there have been no prospective studies of risk factors for falling specific to this patient population, and no successful falls intervention/prevention trials. This prospective study aimed to identify modifiable risk factors for falling in older people with mild to moderate dementia. Methods and Findings 179 participants aged over 65 years were recruited from outpatient clinics in the UK (38 Alzheimer's disease (AD), 32 Vascular dementia (VAD), 30 Dementia with Lewy bodies (DLB), 40 Parkinson's disease with dementia (PDD), 39 healthy controls). A multifactorial assessment of baseline risk factors was performed and fall diaries were completed prospectively for 12 months. Dementia participants experienced nearly 8 times more incident falls (9118/1000 person-years) than controls (1023/1000 person-years; incidence density ratio: 7.58, 3.11–18.5). In dementia, significant univariate predictors of sustaining at least one fall included diagnosis of Lewy body disorder (proportional hazard ratio (HR) adjusted for age and sex: 3.33, 2.11–5.26), and history of falls in the preceding 12 months (HR: 2.52, 1.52–4.17). In multivariate analyses, significant potentially modifiable predictors were symptomatic orthostatic hypotension (HR: 2.13, 1.19–3.80), autonomic symptom score (HR per point 0–36: 1.055, 1.012–1.099), and Cornell depression score (HR per point 0–40: 1.053, 1.01–1.099). Higher levels of physical activity were protective (HR per point 0–9: 0.827, 0.716–0.956). Conclusions The management of symptomatic orthostatic hypotension, autonomic symptoms and depression, and the encouragement of physical activity may provide the core elements for the most fruitful strategy to reduce falls in people with dementia. Randomised controlled trials to assess such a strategy are a priority.
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              Hemiarthroplasty or total hip arthroplasty in recent femoral neck fractures?

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                Author and article information

                Journal
                romm
                Revista de Osteoporosis y Metabolismo Mineral
                Rev Osteoporos Metab Miner
                Sociedad Española de Investigaciones Óseas y Metabolismo Mineral (Madrid, Madrid, Spain )
                1889-836X
                2173-2345
                June 2021
                : 13
                : 2
                : 51-57
                Affiliations
                [06] Madrid orgnameHospital Universitario Doce de Octubre orgdiv1Servicio de Cirugía Ortopédica y Traumatología España
                [03] Mondragón orgnameHospital Alto Deba orgdiv1Unidad de Investigación España
                [01] Mondragón orgnameHospital Alto Deba orgdiv1Servicio de Cirugía Ortopédica y Traumatología España
                [05] Bilbao orgnameRed de Investigación en Servicios de Salud en Enfermedades Crónicas España
                [02] San Sebastián orgnameInstituto de Investigación Sanitaria Biodonostia España
                [04] Baracaldo orgnameInstituto de Investigación de Servicios de Salud Kronikgune España
                Article
                S1889-836X2021000200002 S1889-836X(21)01300200002
                10.4321/s1889-836x2021000200002
                c62110b1-06b3-459c-a197-57b19345090d

                This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 International License.

                History
                : 13 April 2021
                : 22 January 2021
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 26, Pages: 7
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                SciELO Spain

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                dementia,demencia,fractura de cadera,artroplastia,regresión de Cox,hip fractura,arthroplasty,Cox regression

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