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Master Thesis

Fracture de l’extrémité supérieure du fémur chez le sujet de 65 ans et plus : taux de mortalité à 1 an après prise en charge au GHER de janvier 2013 à aout 2017

Abstract : INTRODUCTION : The one-year mortality rate following a GHER-treated fracture of the upper extremity of the femur (FUEF) in the 65-year-old and older age group may be lower than that found in the literature. We analyzed this one-year mortality rate with description and modalities. MATERIALS AND METHODS : Observational, retrospective, single-center study over more than 3 years, concerning patients aged 65 and over, in an orthopedic surgery department, working with the Geriatrics Unit, within the Eastern Réunion Hospital Group. The data collected came from medical records and a medical questionnaire. The objectives of the study were to analyze one-year mortality with a description of the profile of treated patients, a description of the crude death rate at one year and the mortality rate according to patient characteristics. This involves identifying potential factors associated with one-year mortality. We also collected the social and functional characteristics of patients living at one year. RESULTS : Among the 189 patients included during the selected period, we found a crude death rate at one year of 13.2%. Most of these patients, before the fracture, were walking independently (83.6%), enjoyed a natural environment (75.7%) and lived at home (96.3%). Factors possibly associated with mortality were a high ASA score (OR: 2.65 [1.04 - 6.76]), a weighted Charlson score at high age (OR: 1.14 [0.89 - 1.45]), admission to Continuing Care (OR: 1.81 [0.53 - 6.18]), short hospital stay (OR: 0.15 [0.05 - 0.52]) and locoregional anesthesia (OR: 2.48 [0.67 - 9.21]). Due to the number of characteristics to be analyzed and the small number of deaths (25/189), the threshold of significance was lowered to 0.1% in order to minimize bias. Thus, the variables associated with mortality in univariate analysis (p <5%) was no longer in multivariate analysis. For the 164 patients living at one year, 67.1% of them kept their autonomy to walk and 90.9% found their home. DISCUSSION : This study made it possible to objectify a crude mortality rate at one year following an FUEF treated with GHER, relatively lower than those found in national and international studies ranging from 20 to 30%. Our population is comparable in terms of sex ratio M/W and age of occurrence of the FUEF, to that of other studies. However, the results for one-year mortality and the post-surgical autonomy are relatively less dramatic compared to those of European and American studies. There seems to be hope for the FUEF through prevention programs, the optimization of orthogeriatric pathways and adapted home support.
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Master Thesis
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Submitted on : Wednesday, March 11, 2020 - 5:48:34 PM
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Yasmine Mogalia. Fracture de l’extrémité supérieure du fémur chez le sujet de 65 ans et plus : taux de mortalité à 1 an après prise en charge au GHER de janvier 2013 à aout 2017. Médecine humaine et pathologie. 2019. ⟨dumas-02505849⟩

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