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Войти в исследования Risk factors for one-year mortality in 440 femoral peri-implant fractures: insights from the PIPPAS prospective, multicentre, observational study.
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Aguado Héctor J, PIPPAS Study Group, Aguado Héctor J, Castillón-Bernal Pablo, Teixidor-Serra Jordi, García-Sánchez Yaiza, Muñoz-Vives Josep M, Camacho-Carrasco Pilar, Jornet-Gibert Montsant, Ojeda-Thies Cristina, García-Portabella Pablo, Pereda-Manso Adela, Mateos-Álvarez Elvira, García-Virto Virginia, Noriega-González David, Álvarez-Ramos Begoña A, Muñoz-Moreno Mª F, Arroyo-Hernantes Irene, Martínez-Sellés Carmen, Marín-Jiménez Sergio, Acha Adriana, Tomás-Hernández Jordi, Selga-Marsà Jordi, Andrés-Peiró José V, Piedra-Calle Carlos, Blasco-Casado Ferrán, Guerra-Farfán Ernesto, Querolt-Coll Jordi, de Santamaría Guillermo T, Gil-Aliberas Carles, Campuzano-Bitterling Borja, Ajuria Fernández Eliam, Díaz Suárez Rebeca, Fernández Manzano Eugenia, De Cortázar Unai G, Arrieta Mirentxu, Escobar Daniel, Castrillo Estíbaliz, Balvis Patricia, Denisiuk Maciej, Moreta Jesús, Uriarte Xabier, Vea Andrea, Jiménez-Tellería Patricia, Olías-López Beatriz, Amaya-Espinosa Patricia, Boluda-Mengod Juan, Borrás-Cebrián Juan C, Martínez-Pérez Carles, Freile Pazmiño Patricio A, Calavia-Calé Pablo, Suárez-Suárez Miguel Á, García Arias Antonio, Valle-Cruz José, García-Coiradas Javier, Cano Leira María Á, Bonome-Roel César, Benjumea Carrasco Antonio, Chico-García Marcos, Sánchez Pérez Coral, Priego Sánchez Rodrigo J, Pariza Ana L, Fernández-Juan Alexis, Saura-Sánchez Eladio, Giménez-Ibáñez Sandra, Sánchez-Gómez Plácido, Ricón-Recarey F J, Jiménez-Olivares Jesús, Correoso-Castellanos Silvia, García Elena M, Medrano-Morte Isabel, Cuadrado-Abajo Francisco, Laguna-Bercero María E, Pozo-Manrique Pedro D, Navas-García Francisco M G, García-Paredero Ester, Robles Teresa B, Navas-Pernía Inés, Gálvez-Márquez Gonzalo, Villasante-Jirón Ignasi D, Vilanova-Laguna Joan, Videla-Ces Miquel, Serra Porta Teresa, González-Ojeda Gloria, Becerra Carmen C, Pena Paz Silvia, Fernández-Dorado Fátima, Martínez-Menduiña Amaia, Vaquerizo-García Víctor, Murcia-Asensio Antonio, Galián-Muñoz Elena, Marín-Martínez Carmelo, Muñoz-Vicente Adrián, Plaza-Salazar Nuria, Gámez-Asunción Carla, Benito-Santamaría Jennifer, González Ana V, Viana Laura A, Mingo-Robinet Juan, Barbería-Biurrun Amaya, Escudero-Martínez Emma, Chouza-Montero Laura, Naharro-Tobío María, Gasset-Teixidor Alfons, Domínguez-Ibarrola Andrea, Peñalver J M, Serrano-Sanz Jorge, Roche-Albero Adrián, Martín-Hernández Carlos, Macho-Mier María, Segura-Nuez Julián C, Saló-Cuenca José C, Roselló Jordi E, Criado-Albillos Guillermo, Cabello-Benavides Hugo G, Nestar David A, Martínez-Íñiguez Blasco Jorge, Bogallo-Dorado José M, Cano-Porras Juan R, Marqués-López Fernando, Martínez-Díaz Santos, Carabelli Guido S, Slullitel Pablo I, Astore Ignacio, Hernández-Pascual Carlos, Marín-Sánchez Javier, Dot-Pascuet Iván, Piñeiro-Borrero Ana, Pérez-Sánchez José M, Mandía-Martínez Alfonso, Caso-Rodríguez Julio D, Martín-Marcuello Jordi, Benito-Mateo Miguel, Jaúregui-Garasa Ainhoa, Gabarain-Morcillo Imanol, González-Panisello María R, Miñana-Barrios Marta, Iglesias-Fernández Susana, García-Albea Raquel, González-López María C
Аннотация
METHODS: This prospective, multicentre, observational study involved 440 FPIF patients with a minimum one-year follow-up. Data on demographics, clinical features, fracture characteristics, management, and mortality rates were collected and analyzed using both univariate and multivariate analyses. FPIF patients were elderly (median age 87 years (IQR 81 to 92)), mostly female (82.5%, n = 363), and frail: median clinical frailty scale 6 (IQR 4 to 7), median Pfeiffer 4 (1 to 7), median age-adjusted Charlson Comorbidity Index (CCI) 6 (IQR 5 to 7), and 58.9% (n = 250) were American Society of Anesthesiologists grade III.
RESULTS: Overall, 90.5% (n = 398) of the patients were treated surgically, 57.0% (n = 227) retained the implant, and 88.7% (n = 353) managed with fixation. Mortality rates were 8.2% (n = 3.6) in-hospital, 11.4% (n = 50) at 30 days, 21.1% (n = 93) at six months, and 21.6% (n = 95) at 12 months. Medical complications, mainly delirium, were common in the acute setting (52.7%, n = 215). The nonunion rate was 4.1% (n = 18). Mortality risk factors in the univariate analysis were age, living at a nursing home, no walking outdoors, frailty variables, fractures in the distal epiphysis, fractures around a proximal nail, discharge to a healthcare facility, and no osteoporotic treatment at discharge. Protective factors against mortality in the univariate analysis were surgical treatment by an experienced surgeon, management without an arthroplasty, allowing full weightbearing, mobilization in the first 48 hours postoperatively, and geriatric involvement. Risk factors for mortality in the multivariate analysis were cognitive impairment (Pfeiffer's questionnaire) (hazard ratio (HR) 1.14 (95% CI 1.05 to 1.23), p = 0.002), age-adjusted CCI (HR 1.18 (95% CI 1.07 to 1.30), p = 0.001), and antiaggregant or anticoagulant medication at admission (HR 2.00 (95% CI 1.19 to 3.38), p = 0.009). Haemoglobin level at admission was protective against mortality (HR 0.85 (95% CI 0.74 to 0.97), p = 0.018).
CONCLUSION: Mortality in FPIFs occurs mainly within the first six months of follow-up. Early co-management and clinical optimization, particularly targeting frail older patients, is crucial in reducing mortality following these fractures.