Introduction: Elderly subjects have physiological and clinical characteristics that make surgical management more complex and have a major impact on their prognosis. The primary objective of this study was to assess peri-operative hospital morbidity and mortality in the elderly. Secondary objectives were to identify factors predictive of death. Methods: This was a retrospective observational descriptive and analytical study carried out over 02 years, based on hospitalized patient records. It concerned patients aged 65 or over who had undergone surgery or for whom an indication for surgery had been given, all pathologies included. A total of 138 files were collected. The mean age was 74.15 years. Diabetes (n = 52; 37.68%) and arterial hypertension (n = 38; 27.54%) were the most common comorbidities. The reasons for hospitalization were mostly degenerative (n = 56; 40.58%) and traumatic (n = 49; 35.51%) pathologies. Preoperative delay, intraoperative and postoperative complications, hospital stay, evolution (mode of discharge), time of occurrence and presumed cause of death were studied. Univariate (p < 0.2) and multivariate (p < 0.05) binary logistic regression were performed to search for risk factors for death. Results: The mean preoperative delay was 5.53 days (1 - 23). Intraoperative complications were mainly hemodynamic instability (n = 26, 18.8%). Postoperatively, the main complications were anemia (n = 62; 48.44%) and glycemic imbalance (n = 28; 21.86%). Average hospital stay was 13.4 days. Age (>75 years), the existence of comorbidities, degenerative pathologies, ASA score > 2, delay in treatment > 3 days, the occurrence of complications and the blood transfusion requirement were the independent predictors of the occurrence of death in the multifactorial analysis. Conclusion: Peri-operative morbidity in the elderly was influenced by age (>75 years), the existence of comorbidities, degenerative pathologies, ASA score > 2, time to treatment > 3 days, the occurrence of complications and the blood transfusion requirement.
References
[1]
Lee, J.H., Kim, M.J., Hong, J.Y., Myung, J., Roh, Y.H. and Chung, S.P. (2021) The Elderly Age Criterion for Increased In-Hospital Mortality in Trauma Patients: A Retrospective Cohort Study. ScandinavianJournalofTrauma, ResuscitationandEmergencyMedicine, 29, Article No. 133. https://doi.org/10.1186/s13049-021-00950-x
[2]
Wu, S., Rau, C., Kuo, P., Liu, H., Hsu, S. and Hsieh, C. (2018) Significance of Blood Transfusion Units in Determining the Probability of Mortality among Elderly Trauma Patients Based on the Geriatric Trauma Outcome Scoring System: A Cross-Sectional Analysis Based on Trauma Registered Data. InternationalJournalofEnvironmentalResearchandPublicHealth, 15, Article 2285. https://doi.org/10.3390/ijerph15102285
[3]
Parker, M. and Johansen, A. (2006) Hip Fracture. BMJ, 333, 27-30. https://doi.org/10.1136/bmj.333.7557.27
[4]
Ferré, F. and Minville, V. (2011) Stratégie de prise en charge préopératoire visant à diminuer la morbidité et la mortalité de la fracture du col fémoral. AnnalesFrançaisesd’AnesthésieetdeRéanimation, 30, e45-e48. https://doi.org/10.1016/j.annfar.2011.08.008
[5]
Yao, L.B., Krah, K.L., Séry, B.J.L.N., Kouassi, K.J.E., Akobé, A.J.R. and Kodo, M. (2022) Pathologies en Traumatologie-Orthopédie du Centre Hospitalier et Universitaire de Bouaké: Résultats de données épidémiologiques et thérapeutiques. Revue Internationale des Sciences Médicales, 24, 34-45.
[6]
Evano, M., Arrigoni, S. and Rabuel, C. (2019) Fracture du col du fémur du sujet âgé: Comment améliorer le pronostic? RevueduRhumatismeMonographies, 86, 313-317. https://doi.org/10.1016/j.monrhu.2019.05.004
[7]
Aschkenasy, M.T. and Rothenhaus, T.C. (2006) Trauma and Falls in the Elderly. EmergencyMedicineClinicsofNorthAmerica, 24, 413-432. https://doi.org/10.1016/j.emc.2006.01.005
[8]
Guzman-Martinez, A.M., Garcia-Rodriguez, O., Ramos-Melendez, E.O., Guerrios-Rivera, L. and Rodriguez-Ortiz, P. (2018) Morbidity and Mortality of Hispanic Trauma Patients with Diabetes Mellitus. EuropeanJournalofTraumaandEmergencySurgery, 46, 887-893. https://doi.org/10.1007/s00068-018-1047-z
[9]
Yao, L.B., Akobé, A.J.R., Séry, B.N.J.L., M’bra, K.I., Kouassi, K.J.E. and Kodo, M. (2021) Mortalité en Orthopédie-Traumatologie: Aspects épidémiologiques et facteurs de risques. Revue Internationale des Sciences Médicales, 23, 55-62.
[10]
Sammy, I., Lecky, F., Sutton, A., Leaviss, J. and O’Cathain, A. (2016) Factors Affecting Mortality in Older Trauma Patients—A Systematic Review and Meta-Analysis. Injury, 47, 1170-1183. https://doi.org/10.1016/j.injury.2016.02.027
[11]
Keller, J.M., Sciadini, M.F., Sinclair, E. and O’Toole, R.V. (2012) Geriatric Trauma: Demographics, Injuries, and Mortality. JournalofOrthopaedicTrauma, 26, e161-e165. https://doi.org/10.1097/bot.0b013e3182324460
[12]
Åhman, R., Siverhall, P.F., Snygg, J., Fredrikson, M., Enlund, G., Björnström, K., et al. (2018) Determinants of Mortality after Hip Fracture Surgery in Sweden: A Registry-Based Retrospective Cohort Study. ScientificReports, 8, Article No. 15695. https://doi.org/10.1038/s41598-018-33940-8
[13]
Harris, M.J., Brovman, E.Y. and Urman, R.D. (2019) Clinical Predictors of Postoperative Delirium, Functional Status, and Mortality in Geriatric Patients Undergoing Non-Elective Surgery for Hip Fracture. JournalofClinicalAnesthesia, 58, 61-71. https://doi.org/10.1016/j.jclinane.2019.05.010
[14]
Ngboko, A.P.M., Doui, A.D., Service, M.Y., Mapouka, A.P.I. and Nghario, L. (2022) La mortalité suite aux urgences chirurgicales digestives à l’unité de réanimation chirurgicale du Chu de l’amitié sino-centrafricaine de Bangui. Revue Marocaine de Santé Publique, 9, 37-42.
[15]
Daabiss, M. (2011) American Society of Anaesthesiologists Physical Status Classification. IndianJournalofAnaesthesia, 55, 111-115. https://doi.org/10.4103/0019-5049.79879
[16]
Zulfiqar, A., Sui Seng, X., Gillibert, A., Kadri, N., Doucet, J. and Andrès, E. (2017) Anemia in the Elderly: Study of Links with Geriatric Criteria. Hématologie, 23, 379-390. https://doi.org/10.1684/hma.2017.1305
[17]
Collin, C., Bimou, C., Mabit, C., Tchalla, A., Charissoux, J. and Marcheix, P. (2020) Orthogeriatric Assessment of Patients over 75 Years of Age with a Proximal Femur Fracture: Predictors of 6-Month Mortality. Orthopaedics&Traumatology:Surgery&Research, 106, 1441-1447. https://doi.org/10.1016/j.otsr.2020.06.017
[18]
Simunovic, N., Devereaux, P.J., Sprague, S., Guyatt, G.H., Schemitsch, E., DeBeer, J., et al. (2010) Effect of Early Surgery after Hip Fracture on Mortality and Complications: Systematic Review and Meta-analysis. CanadianMedicalAssociationJournal, 182, 1609-1616. https://doi.org/10.1503/cmaj.092220
[19]
Barbry, T. and Coriat, P. (2004) Hypertension artérielle et anesthésie. EMC—Anesthésie-Réanimation, 1, 25-53. https://doi.org/10.1016/j.emcar.2003.02.001
[20]
Scheen, A.J., Paquot, N. and Bauduceau, B. (2014) Le diabète du sujet âgé, du défi épidémiologique à une approche personnalisée. Revue Médicale de Liège, 69, 323-328.
[21]
Donat, N., Ausset, S., Maurice, G.P.d.S., Daban, J., Boutonnet, M. and Auroy, Y. (2008) Anesthésie du sujet âgé: Analyse épidémiologique du risque. Le Praticien en Anesthésie Réanimation, 12, 408-412. https://doi.org/10.1016/j.pratan.2008.10.001
[22]
Roy, R.C. (2000) Choosing General versus Regional Anesthesia for the Elderly. AnesthesiologyClinicsofNorthAmerica, 18, 91-104. https://doi.org/10.1016/s0889-8537(05)70151-6
[23]
Aubrun, F., Baillard, C., Beuscart, J., Billard, V., Boddaert, J., Boulanger, É., et al. (2019) Recommandation sur l’anesthésie du sujet âgé: L’exemple de fracture de l’extrémité supérieure du fémur. Anesthésie & Réanimation, 5, 122-138. https://doi.org/10.1016/j.anrea.2018.12.002
[24]
Bruyère, M. and Taleb, A. (2011) Anesthésie pour fracture du col fémoral chez le sujet âgé. Le Praticien en Anesthésie Réanimation, 15, 3-12. https://doi.org/10.1016/j.pratan.2010.12.004
[25]
Ahmad, R. (2007) Increased Hospital Morbidity among Trauma Patients with Diabetes Mellitus Compared with Age-and Injury Severity Score-Matched Control Subjects. ArchivesofSurgery, 142, 613-618. https://doi.org/10.1001/archsurg.142.7.613
[26]
Evered, L.A., Vitug, S., Scott, D.A. and Silbert, B. (2020) Preoperative Frailty Predicts Postoperative Neurocognitive Disorders after Total Hip Joint Replacement Surgery. Anesthesia&Analgesia, 131, 1582-1588. https://doi.org/10.1213/ane.0000000000004893
[27]
Bai, J., Liang, Y., Zhang, P., Liang, X., He, J., Wang, J., et al. (2019) Association between Postoperative Delirium and Mortality in Elderly Patients Undergoing Hip Fractures Surgery: A Meta-analysis. OsteoporosisInternational, 31, 317-326. https://doi.org/10.1007/s00198-019-05172-7
[28]
Pedemonte, J.C., Sun, H., Franco-Garcia, E., Zhou, C., Heng, M., Quraishi, S.A., et al. (2021) Postoperative Delirium Mediates 180-Day Mortality in Orthopaedic Trauma Patients. BritishJournalofAnaesthesia, 127, 102-109. https://doi.org/10.1016/j.bja.2021.03.033
[29]
Nadelson, M.R., Sanders, R.D. and Avidan, M.S. (2014) Perioperative Cognitive Trajectory in Adults. BritishJournalofAnaesthesia, 112, 440-451. https://doi.org/10.1093/bja/aet420
[30]
Inouye, S.K., Westendorp, R.G. and Saczynski, J.S. (2014) Delirium in Elderly People. TheLancet, 383, 911-922. https://doi.org/10.1016/s0140-6736(13)60688-1
[31]
Benhamou, D. and Brouquet, A. (2016) Postoperative Cerebral Dysfunction in the Elderly: Diagnosis and Prophylaxis. JournalofVisceralSurgery, 153, S27-S32. https://doi.org/10.1016/j.jviscsurg.2016.09.015
[32]
Delaveau, A., Saint-Genez, F., Gayet, L., Paccalin, M., Ounajim, A. and Vendeuvre, T. (2019) Impact of Time to Surgery in Upper Femoral Fracture in Orthogeriatrics. Orthopaedics&Traumatology:Surgery&Research, 105, 975-978. https://doi.org/10.1016/j.otsr.2019.04.018
[33]
Härstedt, M., Rogmark, C., Sutton, R., Melander, O. and Fedorowski, A. (2015) Impact of Comorbidity on 6-Month Hospital Readmission and Mortality after Hip Fracture Surgery. Injury, 46, 713-718. https://doi.org/10.1016/j.injury.2014.12.024
[34]
Mézière, A., Paillaud, E. and Plaud, B. (2013) Anesthésie de la personne âgée. La Presse Médicale, 42, 197-201. https://doi.org/10.1016/j.lpm.2012.07.040
[35]
Turrentine, F.E., Wang, H., Simpson, V.B. and Jones, R.S. (2006) Surgical Risk Factors, Morbidity, and Mortality in Elderly Patients. JournaloftheAmericanCollegeofSurgeons, 203, 865-877. https://doi.org/10.1016/j.jamcollsurg.2006.08.026
[36]
Carles, M. and Raucoules-Aimé, M. (2011) Prise en charge anesthésique du patient diabétique. La Presse Médicale, 40, 587-595. https://doi.org/10.1016/j.lpm.2011.01.017
