Hip fractures in South Africa:mortality outcomes over 12 months post fracture
| Autor: | Farhanah Paruk, Glenda Matthews, Celia L Gregson, Bilkish Cassim |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Male
0301 basic medicine medicine.medical_specialty Multivariate analysis Osteoporosis 030209 endocrinology & metabolism survival Cohort Studies 03 medical and health sciences South Africa 0302 clinical medicine Risk Factors Internal medicine Humans Medicine Orthopedics and Sports Medicine Hospital Mortality Aged Aged 80 and over Hip fracture Hip Fractures business.industry Proportional hazards model Mortality rate Length of Stay medicine.disease mortality osteoporosis Elevated serum creatinine hip fracture Orthopedic surgery Female 030101 anatomy & morphology business Osteoporotic Fractures Cohort study |
| Zdroj: | Paruk, F, Matthews, G, Gregson, C L & Cassim, B 2020, ' Hip fractures in South Africa : mortality outcomes over 12 months post fracture ', Archives of Osteoporosis, vol. 15, no. 1, pp. 76 . https://doi.org/10.1007/s11657-020-00741-4 |
| Popis: | With increased urbanisation and longevity in sub-Saharan Africa, the burden of osteoporosis and resultant hip fractures (HF) has increased. This study shows that 1 in 3 subjects dies post-HF, and that there are significant delays and barriers to surgery, reflecting the need to prioritise HF care in South Africa.PURPOSE: The outcomes following hip fractures are unknown in sub-Saharan Africa. This study aimed to quantify the mortality rate (MR) following hip fractures and to identify predictors of mortality over 1 year.METHODS: In this cohort study, demographic, clinical, and biochemical characteristics of consecutive patients with low trauma hip fractures, admitted to the five public sector hospitals in eThekwini (formerly Durban), were recorded. Cox regression analyses identified predictors of mortality at 30 days and 1 year.RESULTS: In the 200 hip fracture patients studied, the mean age was 74.3 years (SD ± 8.8) and 72% were female. Hospital presentation was often delayed, only 15.5% presented on the day of fracture. At admission, 69.5% were anaemic, 42% had hyponatraemia, 34.5% raised creatinine, and 58.5% hypoalbuminaemia. All received skin traction before 173 (86.5%) underwent surgical fixation. Median time from admission to surgery was 19.0 days (IQR 12.3-25.0). Median hospital stay was 9.0 days (IQR 12.3-25.0). Mortality rates were 13% and 33.5% at 30 and 365 days, respectively. Over 1 year, African patients were more likely to die than Indian patients (40.9 versus 30%, HR 11.5 [95% CI 1.51, 2.57]; p = 0.012); delays to surgery predicted death (HR 1.02 [95% CI (1.00, 1.04)]; p = 0.022). In multivariate analyses, death at 1 year was most strongly predicted by an elevated serum creatinine (HR 2.43, 95% CI (1.02, 5.76), p = 0.044].CONCLUSION: Hip fractures are associated with high MRs, in part explained by insufficient surgical capacity, highlighting the need for national efforts to improve hip fracture service provision. |
| Databáze: | OpenAIRE |
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