Efeito da hospitalização prévia em doentes com fratura da anca na mortalidade aos 12 meses

Introdução: As fraturas da anca tem um elevado custo social e económico, com significativa morbilidade e mortalidade, prevendo-se um aumento da sua incidência com o envelhecimento. As fraturas, assim como as hospitalizações, são fatores que contribuem para o síndrome de fragilidade, e ambas contribuem sinergicamente para o aumento de mortalidade. Será que hospitalizações nos 3 meses prévios a fratura resulta num aumento de mortalidade nos 12 meses subsequentes à fratura? Objetivos: Avaliar a mortalidade aos 12 meses após fratura associada a hospitalização prévia. Materiais e Métodos: este é um estudo de cohort retrospetivo de doentes internados no serviço de Ortopedia do Hospital Sousa Martins com Fratura da Anca de fragilidade entre 1 de janeiro 2017 a 30 de junho 2018 (18 meses). Os dados, colhidos através da revisão de processos, incluíram dados sociodemográficos, tipo de fratura e seu tratamento, mortalidade geral e aos 6, 12 e 24 meses, internamentos nos 3 meses prévios à fratura, comorbilidades e medicação habitual. A amostra foi divida em 2 grupos (com e sem internamento pré-fratura), e foram as avaliadas as diferenças quanto aos dados/ fatores colhidos. A mortalidade foi avaliada relativamente à existência de internamento préfratura, bem como para cada especialidade deste. Resultados: De 538 doentes com fratura da anca, identificou-se 501 doentes com fraturas de fragilidade, dos quais 75,25% do sexo feminino, com idade média de 83,88 ±8,53 anos; destes 71,66% sem fraturas prévias. A mortalidade aos 12 meses foi de 23,15%, não havendo associação significativa relativa ao internamento pré-fratura (23,68%; p=0,936). Uma árvore de classificação identificou a idade, sexo e medicação associada a quedas como fatores determinantes da mortalidade aos 12 meses. Através de uma regressão logística (controlada para idade, sexo e medicação associada a quedas), foi encontrada uma associação significativa entre internamento pré-fratura em Ortopedia e mortalidade aos 12 meses (p=0,042), com odds ratio de 5,145 (CI 95% 1,061 – 24,948). Conclusões: doentes com internamento em Ortopedia prévio a fratura da anca estão em cerca de 5 vezes maior risco para a mortalidade aos 12 meses após fratura.Introduction: Hip fractures have a high socioeconomic cost, with significant morbidity and mortality, and their incidence is expected to increase with aging. Fractures and hospitalization are contributing factors to frailty syndrome, and both contribute to higher mortality. So does hospitalization in the 3 months before fracture result in an increase in mortality in the 12 months post-fracture? Objectives: Assess mortality at 12 months’ post-fracture associated with previous hospitalization. Material and Methods: A retrospective cohort study of all consecutive patients admitted in Orthopedic ward of Hospital Sousa Martins with frailty hip fracture between 1 January 2017 and 30 June 2018 (18 months). All data were collected through revision of patients’ charts and included sociodemographic data, type of fracture, fracture treatment, overall mortality and at 6, 12, and 24 months’ post-fracture, hospitalization in the 3 months before fracture, comorbidities, and chronic medication. The sample was divided into 2 groups (with and without pre-fracture hospitalization), and all variables under study were compared. Mortality was evaluated for the existence of pre-fracture hospitalization and each ward in which it occurred. Results: Of 538 patients with hip fracture, only 501 were identified with frailty fractures, of which 75.25% were female, with a mean age of 83.88 ± 8.53 years; of these, 71.66% with no prior fractures. Mortality at 12 months was 23.15%, with no significant association with pre-fracture hospitalization (23.68%, p=0.936). A classification tree identified age, sex, and fall-associated medication as determinant factors in 12 months’ mortality. Through a logistic regression (controlled for age, sex, and fall-associated medication), a significant association was found between pre-fracture hospitalization in Orthopedic ward and 12 months’ mortality (p=0.042), with a 5.145 odds ratio (CI 95% 1.061 – 24.948). Conclusions: Patients admitted to the Orthopedic ward before a hip fracture are at about 5 times greater risk for mortality at 12 months after fracture

Surgeons’ practice and preferences for the anal fissure treatment: results from an international survey

The best nonoperative or operative anal fissure (AF) treatment is not yet established, and several options have been proposed. Aim is to report the surgeons' practice for the AF treatment. Thirty-four multiple-choice questions were developed. Seven questions were about to participants' demographics and, 27 questions about their clinical practice. Based on the specialty (general surgeon and colorectal surgeon), obtained data were divided and compared between two groups. Five-hundred surgeons were included (321 general and 179 colorectal surgeons). For both groups, duration of symptoms for at least 6 weeks is the most important factor for AF diagnosis (30.6%). Type of AF (acute vs chronic) is the most important factor which guide the therapeutic plan (44.4%). The first treatment of choice for acute AF is ointment application for both groups (59.6%). For the treatment of chronic AF, this data is confirmed by colorectal surgeons (57%), but not by the general surgeons who prefer the lateral internal sphincterotomy (LIS) (31.8%) (p = 0.0001). Botulin toxin injection is most performed by colorectal surgeons (58.7%) in comparison to general surgeons (20.9%) (p = 0.0001). Anal flap is mostly performed by colorectal surgeons (37.4%) in comparison to general surgeons (28.3%) (p = 0.0001). Fissurectomy alone is statistically significantly most performed by general surgeons in comparison to colorectal surgeons (57.9% and 43.6%, respectively) (p = 0.0020). This analysis provides useful information about the clinical practice for the management of a debated topic such as AF treatment. Shared guidelines and consensus especially focused on operative management are required to standardize the treatment and to improve postoperative results