Proksimal femur kırıklarında cerrahi zamanlama erken mortaliteyi etkilemez: tek merkez deneyimi

Year 2025, Volume: 18 Issue: 4, 1 - 1

Kemal Şibar , Abdulsamet Emet , Erkan Akgün , Hüseyin Emre Tepedelenlioğlu , Yasin Erdoğan , Turgut Yurdakul , Ahmet Fırat

Abstract

Amaç: Bu çalışmada, proksimal femur kırığı olan geriatri hastalarında cerrahi zamanlama ile 30 günlük ve 90 günlük mortalite arasındaki ilişkiyi araştırmak amaçlanmıştır. Ayrıca, literatürde bu tür kırıklar için ideal cerrahi zamanı konusundaki devam eden tartışmayı ele alarak, mortaliteyi potansiyel olarak etkileyebilecek diğer parametreler de değerlendirildi.
Hastalar ve yöntem: 65 yaş ve üzeri femoral boyun kırığı veya intertrokanterik femur kırığı olan 181 hastanın retrospektif analizi yapıldı. Demografik veriler, komorbiditeler, kırık tipi, cerrahi zamanı ve mortalite hakkında veriler toplandı. Hastalar, ameliyat zamanlamasına göre dört gruba ayrıldı: 24 saat içinde, 24-48 saat içinde, 48-72 saat içinde ve 72 saatten sonra. İstatistiksel analizler t-testleri, Mann-Whitney U testleri, Ki-kare testleri ve Bonferroni düzeltmeli post hoc analizlerini içeriyordu. p<0.05 anlamlılık düzeyi kullanıldı.
Bulgular: Toplam 30 günlük ve 90 günlük ölüm oranları sırasıyla %3,86 ve %11,04'tü. Cerrahi zamanı, 30 günlük ve 90 günlük mortaliteyi önemli ölçüde etkilemedi. En yüksek 30 günlük ölüm oranı (%6,7), ilk 24 saat içinde ameliyat edilen hastalarda gözlemlendi; bu durum, muhtemelen aceleci preoperatif hazırlıklardan kaynaklanıyor. En yüksek 90 günlük ölüm oranına sahip grup (%22), muhtemelen komorbiditeler veya antikoagülan kullanımı tarafından etkilenmiş olan 72 saatten sonra ameliyat olan hastalardan oluşuyordu.
Sonuç: Cerrahi zamanlama, proksimal femur kırıklarında mortaliteyi önemli ölçüde etkilemez, ancak en güvenli aralık 24-72 saat gibi görünmektedir. Erken cerrahi, immobilizasyonla ilgili komplikasyonları azaltabilirken, preoperatif optimizasyon için yeterli zaman kritik öneme sahiptir. Hasta hazırlığına odaklanan dengeli bir yaklaşım, katı zamanlama yönergeleri yerine daha iyi sonuçlar sağlar.

Keywords

Kalça kırığı, cerrahi zamanlama, mortalite

Surgical timing for proximal femur fractures is not affect early mortality: single center experience

Abstract

Purpose: This study investigates the relationship between surgical timing and 30-day and 90-day mortality in geriatric patients with proximal femur fractures. It also evaluates other parameters potentially affecting mortality, addressing the ongoing debate in the literature about the ideal surgical timing for such fractures.
Patients and methods: A retrospective analysis of 181 patients aged 65 and older with femoral neck or intertrochanteric femur fractures was conducted. Data on demographics, comorbidities, fracture type, surgical timing, and mortality were collected. Patients were categorized into four groups based on surgery timing: within 24 hours, 24-48 hours, 48-72 hours, and after 72 hours. Statistical analyses included t-tests, Mann-Whitney U tests, Chi-square tests, and Bonferroni-corrected post hoc analyses. A significance level of p<0.05 was used.
Results: The overall 30-day and 90-day mortality rates were 3.86% and 11.04%, respectively. Surgical timing did not significantly affect 30-day and 90-day mortality. The highest 30-day mortality rate (6.7%) was observed in patients operated on within the first 24 hours, potentially due to rushed preoperative preparations. The group with the highest 90-day mortality rate (22%) consisted of patients undergoing surgery after 72 hours, likely influenced by comorbidities or anticoagulant use.
Conclusion: Surgical timing does not significantly affect mortality in proximal femur fractures, though the safest interval appears to be 24-72 hours. While early surgery can reduce complications related to immobilization, sufficient time for preoperative optimization is crucial. A balanced approach focusing on patient readiness rather than rigid timing guidelines ensures better outcomes.

Keywords

Hip fracture, surgical timing, mortality

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