Analiza bolničke smrtnosti kod bolesnika sa prelomom proksimalnog dela femura operativno lečenog metodama artroplastike kuka
Sažetak
Uvod/Cilj. Fraktura proksimalnog dela femura je vodeći uzrok smrti od povreda kod starijih bolesnika, kao i veliko opterećenje za nacionalne zdravstvene službe. Analiza bolničke smrtnosti je važna da bi se ustanovili faktori rizika, napravila adekvatna selekcija bolesnika, i sprovelo adekvatno lečenje pre- i postoperativnih infekcija. Cilj ove studije bio je analiza bolničke smrtnosti kod bolesnika operativno lečenih artroplastikom kuka zbog preloma proksimalnog femura. Metode. Pratili smo 622 uzastopna bolesnika sa prelomom proksimalnog dela femura i analizirali starost, pol, prisustvo preoperativne i postoperativne infekcije, skor Američkog udruženja anesteziologa (ASA), prisustvu dijabetes melitusa i vrstu operativne metode. Postoperativne infekcije uključivale su pneumoniju, urinarnu infekciju, infekciju operativnog mesta (IOM) i sepsu. Rezultati. Našli smo statistički značajan uticaj preoperativnog i postoperativnog postojanja infekcije na hospitalnu smrtnost sa relativnim rizikom od smrtnog ishoda 4,53 (95% CI: 1,44–14,22) kod bolesnika sa preoperativnom infekcijom i 7,5 (95% CI: 1,90–29,48) kod bolesnika sa postoperativnom infekcijom. Nije registrovan statistički značajan uticaj starosti, pola, ASA skora, dijabetesa melitusa ili vrste operativne metode na povećanje mortaliteta u toku hospitalizacije. Zaključak. Adekvatna preoperativna selekcija, procena rizika i preduzimanje adekvatnih terapijskih mera u cilju lečenja infekcija od ključnog su značaja za smanjenje rizika smrtnog ishoda u toku hospitalizacije kod bolesnika operisanih zbog preloma proksimalnog femura metodama artroplastike kuka. Posebnu pažnju potrebno je obratiti na prisustvo preoperativne i postoperativne infekcije kod operisanih zbog povećanog rizika od smrtnog ishoda u toku hospitalizacije.
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