Complicaciones post operatorias de fractura de cadera: artroplastia vs osteosíntesis en el Hospital Nacional Adolfo Guevara Velasco de Cusco, 2017-2022

Abstract

Introducción: En la senectud la fractura proximal de fémur es un problema de salud que va en aumento en los últimos años, el tratamiento por el cual se opta es el quirúrgico, artroplastia u osteosíntesis, el cual ha demostrado mejores resultados. Objetivo: Determinar la diferencia de complicaciones post operatorias en pacientes con fractura de cadera tratados con artroplastia vs osteosíntesis en el Hospital Nacional Adolfo Guevara Velasco-Cusco, 2017-2022. Método: Se llevó a cabo un estudio observacional, correlacional, transversal y retrospectivo, donde se revisaron 151 historias clínicas de pacientes intervenidos quirúrgicamente con artroplastia u osteosíntesis por fractura de cadera que cumplieron los criterios de inclusión. Resultados: 57 (37.7%) pacientes presentaron al menos una complicación, de ellos 35 (61.4%) fueron tratados con artroplastia y 32 (38.6%) con osteosíntesis; se encontró un total de 75 complicaciones, la artroplastia presento mayor frecuencia de complicaciones médicas siendo 31 (72.1%) complicaciones y la osteosíntesis presentó mayor frecuencia de complicaciones propias de la cirugía con 17 (53.1%) complicaciones. Se hallaron como características asociadas a complicaciones post operatorias a: alta comorbilidad (OR=3.35, IC95%[1.50-7.46], p=0.003), ASA III-IV (OR=3.21, IC95%[1.55-6.66], p=0.002), el tipo de fractura (OR=2.57, IC95%[1.16-5.68], p=0.019) y estancia hospitalaria post cirugía mayor a 7 días (OR=15.17, IC95%[5.86-39.23], p=0.000). Conclusiones: 57 (37.7 %) pacientes presentaron al menos una complicación post operatoria, la artroplastia presentó mayor frecuencia de complicaciones médicas, y la osteosíntesis presentó mayor frecuencia de complicaciones propias de la cirugía; se encontraron como características asociadas a la presencia de complicaciones a la alta comorbilidad, ASA III-IV, tipo de fractura y estancia hospitalaria post cirugía mayor a 7 días.

Introduction: In old age, proximal femur fracture is a health problem that has been increasing in recent years, the treatment chosen is surgical, arthroplasty or osteosynthesis, which has shown better results. Objective: To determine the difference in postoperative complications in patients with hip fracture treated with arthroplasty vs. osteosynthesis at the Adolfo Guevara Velasco-Cusco National Hospital, 2017-2022. Method: An observational, correlational, cross-sectional and retrospective study was carried out, where 151 medical records of patients who underwent surgery with arthroplasty or osteosynthesis for hip fracture who met the inclusion criteria were reviewed. Results: 57 (37.7%) patients presented at least one complication, of which 35 (61.4%) were treated with arthroplasty and 32 (38.6%) with osteosynthesis; A total of 75 complications were found, arthroplasty presented a higher frequency of medical complications with 31 (72.1%) complications and osteosynthesis presented a higher frequency of complications typical of surgery with 17 (53.1%) complications. Characteristics associated with postoperative complications were found to be: high comorbidity (OR=3.35, 95%CI[1.507.46], p=0.003), ASA III-IV (OR=3.21, 95%CI[1.55-6.66], p= 0.002), the type of fracture

(OR=2.57, 95%CI[1.16-5.68], p=0.019) and post-surgery hospital stay longer than 7 days

(OR=15.17, 95%CI[5.86-39.23], p=0.000) . Conclusions: 57 (37.7%) patients presented

at

least one postoperative complication, arthroplasty presented a higher frequency of medical complications, and osteosynthesis presented a higher frequency of complications typical of surgery; Characteristics associated with the presence of complications were found to be high comorbidity, ASA III-IV, type of fracture, and post-surgery hospital stay longer than 7 days.