Are we Ready for Hip Fracture Geriatric Patients? Study with 224 Patients of the Fourth Age

Luiz Eduardo Imbelloni¹*, Douglas M P Teixeira², Umberto Lima³, Marcos Guedes Miranda Junior⁴, Ana Raquel Araruna Soares⁴ and Geraldo Borges de Morais Filho⁵

Received: November 28, 2019;   Published: December 03, 2019

DOI: 10.32474/OSMOAJ.2019.03.000159

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Abstract

Background: The demographic criterion by age group, that of the old-old, 80 years old or older, so-called the Fourth Age. In Brazil, in 2018 there are four million people in the fourth age. As life expectancy increases, the number of geriatric patients coming for surgery and anesthesia will make up an increasing portion of our practice. The primary aim of orthopedic treatment for these elderly patients can be a return to independent life, that is, independent walking, dressing, toilet functions and eating. The primary objective of this study is to evaluate the implementation of project acceleration of postoperative recovery (fast track surgery), in the Fourth Age patients undergoing hip fracture surgery under spinal anesthesia and peripheral block for postoperative analgesia. The second objective was to assess the need for ICU, length of stay, abbreviation of preoperative and postoperative fasting, oral food reintroduction and mortality in the first month after surgery.

Methods: We studied a longitudinal prospective study in patients over the age of 80 years (Four Age) undergoing corrective hip fracture, of both genders from 1st July 2012 to 30 December 2018, at a hospital covered by the Brazilian Public Health System (SUS). Information on the preoperative condition of these patients, abbreviation for fasting, hunger and thirst assessment, mode of anesthesia, drugs used, intra-operatively measured variables (e.g. hemodynamics, blood loss) and immediate post-operative variables measured in the post-anesthesia care unit (PACU), quality of lumbar plexus block analgesia, presence of delirium in the first day of postoperative was obtained from the study protocol and death in the first postoperative month.

Results: During the period of study (six years) 224 Fourth Age patients underwent surgery for a fracture of the hip, of whom 163 (73%) were women and 61 (27%) were men (Table 1). Prior to injury, all of the patients were living at home. The average hospital stay in all 224 patients was 9.5±6.9 days, and there is an association between age and length of stay. The mean fasting time was 2:56±0:38 hours (Table 2), and no significant difference between the three groups. All patients were submitted to spinal anesthesia. The dose ranged from 6 to 15mg, with a mean of 9.54± 1:64 mg isobaric bupivacaine. The cephalad dispersion varied between T12 and T5, in all patients, and the mode was the same T11 regardless of age group of patients. The duration of the spinal block was 2:44±0:37 hours, the time for the use of dextrinomaltose in PACU was 1:43±0:46 hours, the time in the PACU was 2:03±0:43 hours and the time to reintroduce normal meals were 6:09±1:02 hours. Arterial hypotension occurred in 6 patients and delirium in 13 patients. Of the 224 patients, only 4 (1.8%) were referred to the ICU due to surgical problems. There were no deaths directly related to anesthesia or surgery.

Conclusion: The implementation of the ACERTO Project in Fourth Age patients of the Brazilian Public Health System (SUS), showed that there was a marked improvement in length of stay, patient satisfaction, decreased use of bladder tube and drains, and referral to ICU, with early discharge to residence.

Keywords: Surgery; Orthopedic; Spinal anesthesia; Fasting; Perioperative care; Fast-track surgery

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