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Predictors of outcomes after internal fixation of periprosthetic femoral hip fractures Subgroup analysis of the peri-implant and peri-prosthetic fractures Spanish registry (PIPPAS)

Abstract: Purpose: To identify risk factors predisposing patients to poor outcomes after fixation of periprosthetic hip fractures around femoral stems. Methods: Prospective multicentre cohort study of fractures around a hip replacement stem managed by internal fixation. The primary outcome was one-year mortality, while secondary outcomes were local complications and healthcare burden-related outcomes (nursing facility utilization and hospital length of stay). Results: One-year mortality was 16.2%. Age-adjusted Charlson Comorbidity Index score (OR=1.17; 95%CI=1.03-1.33)), Pfeiffer Short Portable Mental Status Questionnaire (SPMSQ) score (OR=1.16; 1.06-1.28), prosthetic dysfunction (OR=1.90; 1.00-3.61), and postoperative medical complications (OR=1.97; 1.06-3.68) were predictors of mortality. Patients with prior prosthetic dysfunction, lower Pfeiffer SPMSQ scores, Vancouver A fractures, and fractures fixed only using cerclages were at higher risk of local complications, which occurred in 9.3% of cases. Medical (OR=1.81; 1.05-3.13) and local complications (OR=5.56; 2.42-3.13) emerged as consistent risk factors for new institutionalization. Average hospitalization time was 13.9±9.2 days. Each day of fixation delay led to an average 1.4-day increase in total hospitalization. Conclusion: Frail periprosthetic hip-fracture patients with poorer functional status, dysfunctional replacements, and postoperative complications are at increased risk of mortality. Postoperative complications are more common in patients with dysfunctional arthroplasties, Vancouver A fractures, and fixation using cerclages alone. Postoperative complications were the most consistent predictor of higher healthcare resource utilization.

 Fuente: Injury, 2024, 55, 111715

 Editorial: Elsevier

 Año de publicación: 2024

 Nº de páginas: 9

 Tipo de publicación: Artículo de Revista

 DOI: 10.1016/j.injury.2024.111715

 ISSN: 0020-1383,1879-0267

 Url de la publicación: https://doi.org/10.1016/j.injury.2024.111715

Autoría

ANDRÉS-PEIRÓ, JOSÉ

NOMDEDÉU, JOSEP

AGUADO, HÉCTOR J.

GONZÁLEZ-MORGADO, DIEGO

MINGUELL-MONYART, JOAN

JOSHI-HUBERT, NAYANA

TEIXIDOR-SERRA, JORDI

TOMÀS-HERNÁNDEZ, JORDI

SELGA-MARSÀ, JORDI

GACÍA-SÁNCHEZ, YAIZA

NORIEGA-GONZÁLEZ, DAVID C.

MATEOS-ÁLVAREZ, ELVIRA

PEREDA-MANSO, ADELA

CERVERA-DÍAZ, M. CARMEN

BALVIS-BALVIS, PATRICIA

GARCÍA-PÉREZ, ÁNGELA

FRANCISCO CUADRADO ABAJO

SARA GARCIA GONZALEZ