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Master Thesis

Évaluation rétrospective d’un protocole de prise en charge anesthésique des chirurgies urgentes de l’extrémité supérieure du fémur chez le patient de plus de 75 ans. Devenir à distance des patients

Abstract : Introduction: hip fracture (HF) in the elderly is a significant public health problem, with substantial associated mortality and disability. New recommendations from the SFAR (Société Française d’Anesthésie et de Réanimation) were published in 2017 on perioperative anaesthetic care for elderly patients undergoing emergency HF surgery. We developed a perioperative anaesthetic protocol based on these recommendations and assessed its effect on patient outcomes. Methods: over two 3-month periods, before and after protocol implementation, all consecutive patients older than 75 years with a diagnosis of HF admitted to the emergency unit of CHU Pellegrin for surgery, from 1st January, 2017 to 31st March, 2017, and from 15th January, 2018 to 15th April, 2018, were included in this retrospective, observational, monocentric study. Perioperative data (preoperative, intraoperative, in-hospital and post-discharge outcomes) were recorded for each patient. The primary outcome was postoperative (6-month) all-cause mortality. The secondary outcomes were morbidities, hospital mortality, autonomy, mobility and institutionalisation at 6 months and 1 year. Results: in total, 135 patients were included in this study; 67 in the “before” protocol group and 68 in the “after” protocol group. Six-month mortality was not different between the “before” and “after” protocol patients (14.5% vs. 15.4%, p = 0.99), of whom 61.2% and 48.5% experienced postoperative delirium, respectively (p = 0.16). At 6 months, among the before and after protocol patients with an independent preoperative functional status, 29.0% and 21.9% required partial or total assistance for daily living activities, respectively. Factors significantly associated with mortality at 6 months were a surgical delay > 1 day and the absence of vasopressor support. Conclusions: the perioperative anaesthetic protocol was not associated with any change in the 6-month mortality of elderly patients undergoing emergency HF surgery.
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https://dumas.ccsd.cnrs.fr/dumas-02863653
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Submitted on : Wednesday, June 10, 2020 - 2:17:16 PM
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Laura Lucas. Évaluation rétrospective d’un protocole de prise en charge anesthésique des chirurgies urgentes de l’extrémité supérieure du fémur chez le patient de plus de 75 ans. Devenir à distance des patients. Sciences du Vivant [q-bio]. 2020. ⟨dumas-02863653⟩

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