Análise epidemiológica de pacientes idosos com fratura do terço proximal do fêmur entre 2019 e 2022
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TCC
Data de publicação
2023-11-27
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Citações (Scopus)
Autores
Yonegura, Bruno Hashimoto
Almeida, Matheus de
Almeida, Matheus de
Orientador
Zini, Cassio
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Introdução: O aumento da expectativa de vida, consequentemente levando ao envelhecimento da população tem causado um aumento significativo no número de fraturas do terço proximal do fêmur. Essas fraturas são comuns e especialmente graves na população idosa, assim, se relacionando com altas taxas de mortalidade, morbidade e custos à saúde. Em relação às fraturas proximais, elas podem ser classificadas em fraturas de cabeça, de colo, transtrocantéricas e região subtrocantérica. Pesquisas, como a de Soares et al, mensuram que a sobrevida dos pacientes que sofrem esse tipo de fratura é reduzida de 15% a 20%, com as taxas de mortalidade relacionadas à fratura de fêmur variando de 15% a 50% no primeiro ano. As informações mais recentes sobre fraturas de fêmur em idosos no Brasil reportam cerca de 30 mil casos/ano, sendo responsáveis, em 2008, por 32.908 internações hospitalares no Sistema Único de Saúde (SUS), com um custo total de 58,6 milhões de reais. Objetivo: Analisar o perfil epidemiológico e a sobrevida dos pacientes idosos, com 60 anos ou mais, atendidos no Hospital Evangélico Mackenzie (HUEM) com diagnóstico de fratura do terço proximal do fêmur e compará-lo com a literatura. Metodologia: Estudo retrospectivo, observacional e transversal, realizado no serviço de ortopedia do Hospital Universitário Evangélico Mackenzie do Paraná. Foram estudados prontuários de pacientes admitidos no serviço de ortopedia no período de janeiro de 2019 a dezembro de 2022, pesquisados a partir da Classificação Internacional de Doenças (CID) S72.0 e S72.1 nos prontuários. A presença de óbito ou não foi confirmada por meio de obituários eletrônicos, cancelamento de CPF e contato por meio do telefone de contato constado no prontuário. A amostra selecionada foi de N=676 pacientes, que se encaixaram nos critérios de inclusão. A análise de sobrevivência foi realizada a partir de curvas de sobrevivência, através do método não paramétrico de Kaplan-Meier e a análise estatística foi feita pelos testes do qui-quadrado, considerando significância quando p ≤ a 0,05. Resultados: O sexo feminino demonstrou uma predominância sobre o sexo masculino, em uma proporção de 2,46 mulheres por homem. O tipo de fratura com maior prevalência foi a fratura transtrocantérica (59,36% no sexo feminino e 55,06% no sexo masculino). O mecanismo de trauma mais frequente foi relatado pela queda de mesmo nível (90,17%). Quanto ao local do acidente, 62,99% ocorreram em ambiente domiciliar. Há uma relação proporcional do aumento da mortalidade com o avanço da idade. O tempo de sobrevivência do sexo feminino foi de 275,90 dias e o sexo masculino 220,36 dias. A probabilidade de sobrevivência gira em torno de 75% após um ano da fratura. As doenças cardiovasculares foram as mais prevalentes (37,80%). Conclusão: As fraturas de fêmur proximal possuem uma maior prevalência no sexo feminino e o mecanismo de trauma predominante se dá por quedas de mesmo nível. As comorbidades mais presentes no estudo foram a hipertensão arterial sistêmica e diabetes mellitus. Fatores como a idade e o ASA tiveram relação diretamente proporcional com a mortalidade, sendo que o envelhecimento possui maior relevância.
Introduction: The increase in life expectancy, consequently leading to the aging of the population, has caused a significant increase in the number of proximal femur fractures. These fractures are common and especially serious in the elderly population, thus being associated with high rates of mortality, morbidity and health costs. Regarding proximal fractures, they can be classified into head, neck, transtrochanteric and subtrochanteric region fractures. Research, such as that by Soares et al, measures that the survival rate of patients who suffer this type of fracture is reduced by 15% to 20%, with mortality rates related to femoral fractures ranging from 15% to 50% in the first year. The most recent information on femur fractures in the elderly in Brazil reports around 30 thousand cases/year, being responsible, in 2008, for 32,908 hospital admissions in the Unified Health System (SUS), with a total cost of 58.6 million real. Objective: To analyze the epidemiological profile and survival of elderly patients, aged 60 or over, treated at Hospital Evangélico Mackenzie (HUEM) with a diagnosis of proximal femur fracture and compare it with the literature. Methodology: Retrospective, observational and cross-sectional study, carried out in the orthopedics service of the Hospital Universitário Evangélico Mackenzie do Paraná. Medical records of patients admitted to the orthopedics service from January 2019 to December 2022 were studied, researched using the International Classification of Diseases (ICD) S72.0 and S72.1 in medical records. The presence of death or not was confirmed through electronic obituaries registration status of the Individual Taxpayer Registry (CPF) of all patients on the Federal Revenue website and contact via the contact telephone number stated in the medical record. The selected sample was N=676 patients, who met the inclusion criteria. Survival analysis was performed using survival curves, using the non-parametric Kaplan-Meier method and statistical analysis was performed using chi-square tests, considering significance when p ≤ 0.05. Results: The female sex demonstrated a predominance over the male sex, in a ratio of 2.46 women per man. The most prevalent type of fracture was transtrochanteric fracture (59.36% in females and 55.06% in males). The most frequent trauma mechanism was reported by falling from the same level (90.17%). As for the location of the accident, 62.99% occurred at home. There is a proportional relationship between the increase in mortality and increasing age. The survival time for females was 275.90 days and for males 220.36 days. The probability of survival is around 75% one year after the fracture. Cardiovascular diseases were the most prevalent (37.80%). Conclusion: Proximal femur fractures are more prevalent in females and the predominant mechanism of trauma is falls from the same level. The comorbidities most present in the study were systemic arterial hypertension and diabetes mellitus. Factors such as age and ASA had a directly proportional relationship with mortality, with aging having greater relevance.
Introduction: The increase in life expectancy, consequently leading to the aging of the population, has caused a significant increase in the number of proximal femur fractures. These fractures are common and especially serious in the elderly population, thus being associated with high rates of mortality, morbidity and health costs. Regarding proximal fractures, they can be classified into head, neck, transtrochanteric and subtrochanteric region fractures. Research, such as that by Soares et al, measures that the survival rate of patients who suffer this type of fracture is reduced by 15% to 20%, with mortality rates related to femoral fractures ranging from 15% to 50% in the first year. The most recent information on femur fractures in the elderly in Brazil reports around 30 thousand cases/year, being responsible, in 2008, for 32,908 hospital admissions in the Unified Health System (SUS), with a total cost of 58.6 million real. Objective: To analyze the epidemiological profile and survival of elderly patients, aged 60 or over, treated at Hospital Evangélico Mackenzie (HUEM) with a diagnosis of proximal femur fracture and compare it with the literature. Methodology: Retrospective, observational and cross-sectional study, carried out in the orthopedics service of the Hospital Universitário Evangélico Mackenzie do Paraná. Medical records of patients admitted to the orthopedics service from January 2019 to December 2022 were studied, researched using the International Classification of Diseases (ICD) S72.0 and S72.1 in medical records. The presence of death or not was confirmed through electronic obituaries registration status of the Individual Taxpayer Registry (CPF) of all patients on the Federal Revenue website and contact via the contact telephone number stated in the medical record. The selected sample was N=676 patients, who met the inclusion criteria. Survival analysis was performed using survival curves, using the non-parametric Kaplan-Meier method and statistical analysis was performed using chi-square tests, considering significance when p ≤ 0.05. Results: The female sex demonstrated a predominance over the male sex, in a ratio of 2.46 women per man. The most prevalent type of fracture was transtrochanteric fracture (59.36% in females and 55.06% in males). The most frequent trauma mechanism was reported by falling from the same level (90.17%). As for the location of the accident, 62.99% occurred at home. There is a proportional relationship between the increase in mortality and increasing age. The survival time for females was 275.90 days and for males 220.36 days. The probability of survival is around 75% one year after the fracture. Cardiovascular diseases were the most prevalent (37.80%). Conclusion: Proximal femur fractures are more prevalent in females and the predominant mechanism of trauma is falls from the same level. The comorbidities most present in the study were systemic arterial hypertension and diabetes mellitus. Factors such as age and ASA had a directly proportional relationship with mortality, with aging having greater relevance.
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fratura , fêmur , idosos , epidemiologia , mortalidade , femur , fracture , seniors , epidemiology , mortality