Meðferð og afdrif sjúklinga með mjaðmarbrot

Abstract

Inngangur: Mjaðmarbrot eru algeng meðal aldraðra, oft með alvarlegum afleiðingum og hárri dánartíðni. Markmið þessarar rannsóknar var að kanna meðferð og afdrif sjúklinga sem hlutu mjaðmarbrot og voru meðhöndlaðir á Landspítala. Efniviður og aðferðir: Afturskyggn rannsókn á öllum sjúklingum ≥60 ára sem gengust undir skurðaðgerð á Landspítala árið 2011 vegna mjaðmarbrots. Niðurstöður: Rannsóknarhópurinn samanstóð af 255 sjúklingum (meðalaldur 82 ± 8 ár, konur 65%). Bið eftir aðgerð frá komu á spítalann var að meðaltali 22 ± 14 klukkustundir. Meðallegutími sjúklinga á spítalanum sem voru á hjúkrunarheimili fyrir brot var 4 ± 2 dagar en meðallegutími þeirra sem bjuggu á eigin heimili 14 ± 10 dagar (p Ályktun: Samsetning hópsins sem mjaðmarbrotnar hér á landi er áþekk því sem gerist erlendis. Meðalbiðtími eftir aðgerð var tæpur sólarhringur, sem er innan marka erlendra gæðastaðla, en þriðjungur sjúklinga beið lengur. Umönnunarúrræði utan sjúkrahúss virtust helst ráða hversu löng sjúkrahúsdvölin varð. Marktækt færri gátu búið á eigin heimili eftir brot en fyrir. Dánarhlutfall mjaðmarbrotinna var margfalt hærra en í sama aldursþýði á Íslandi og í efri mörkum miðað við erlendar rannsóknir. Mjaðmarbrot hafa því alvarlegar afleiðingar fyrir einstaklinginn og eru krefjandi fyrir samfélagið.

Introduction: Hip fractures are common amongst the elderly, often with serious consequences and increased mortality. The aim of this study was to describe treatment and outcome of patients with hip fractures. Material and methods: Retrospective study on all hip fracture patients ≥60 years of age operated at Landspitali University Hospital in the year 2011. Results: The study group was made up of 255 patients (mean age 82 ± 8 years, women 65%). Mean delay to operation was 22 ± 14 hours. Mean length of hospital stay for those living at a nursing home before hip fracture was 4 ± 2 days but if they had lived at home 14 ± 10 days (p<0.001). Before the fracture 68% of the patients lived at home but 54% at the end of follow-up (p<0.001). Mortality one year after hip fracture was 27% and on average eightfold compared to the general population ≥60 years. A multivariate analysis showed that age, time from fracture to arrival at hospital, ASA-classification and living in a nursing home before fracture were linked to an increased risk of death. Conclusion: The mean delay to surgery was within recommended guidelines, but one- third waited longer than 24 hours. Resources outside hospital seemed to decide hospital length of stay. Mortality of hip fracture patients was manifold compared to the general population of the same age and within higher range compared to other countries. Significantly fewer lived in their own home after the fracture. Hip fractures cause serious debilitation and are demanding for society.