Hip fracture in a developing country: a picture in need of change

• Autor(a) principal: Vidal, Edison Iglesias de Oliveira [UNESP]
• Data de Publicação: 2014
• Outros Autores: Moreira Filho, Djalma de Carvalho, Pinheiro, Rejane Sobrino, Souza, Romulo Cristovão, Almeida, Liz Maria de, Camargo Jr., Kenneth Rochel de, Boas, Paulo José Fortes Villas [UNESP], Fukushima, Fernanda Bono [UNESP], Coeli, Cláudia Medina
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Institucional da UNESP
• Texto Completo: http://www.jarcp.com/603-hip-fracture-in-a-developing-country-a-picture-in-need-of-change.html; http://hdl.handle.net/11449/136850
• topic: Hip fractures; Osteoporosis; Quality of health care; Developing countries; Brazil

Objectives: To describe the clinical profile, patterns of care and mortality rates of aged patients who have undergone hip fracture surgical repair. Design: Retrospective patient record study. Setting: A public university hospital in Rio de Janeiro, Brazil. Participants: 352 patients aged 60 and older who underwent surgery for hip fracture between 1995-2000. Measurements: Sociodemographic data, type of fracture, cause of fracture, time from fracture to surgery, physical status, Charlson comorbidity index, type of surgery and anesthesia, access to in-hospital physiotherapy, use of antibiotic and thromboembolism prophylaxis, and mortality within one year after hospital admission. Results: Among 352 subjects, 74.4% were women. The mean age overall was 77.3 years. Very long delays from the time of fracture to hospital admission (mean 3 days) and from hospital admission to surgery (mean 13 days) were observed. Most femoral neck fractures (82.7%) were managed by hip arthroplasties, while 92.8% of the intertrochanteric fractures underwent internal fixation procedures. Less than 10% of patients received in-hospital physiotherapy. Mortality rates 30 days, 90 days and one year after hospital admission were 3.4%, 8.0% and 13.4%, respectively. Conclusion: Our study provides evidence within the context of a developing country of major gaps in the quality of care of vulnerable older adults who suffered a hip fracture. Our findings suggest that hip fracture has not been treated as an urgent condition or a priority within the Brazilian public healthcare system. Further research should address current patterns of care for hip fracture in Brazil and in other developing countries.