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Anaesth. pain intensive care. 2022; 26(5): 608-615

Accelerated Operative Recovery in Elderly Patients with Femoral Fractures. Experience for Ten Years with 870 Patients

Douglas M. P Teixeira, LUIZ EDUARDO IMBELLONI, Umberto Lima, Thaís Bezerra Ventura, Siddharta Lacerda, Bruno Brasileiro, Robson Barbosa, Micaela B. L Sales, Márcio Duarte, Geraldo Borges Morais Filho.


Background: The WHO considers elderly as an individual who is 60 years of age or older, with 37.7 million are elderly people. In 2006, the Acerto project was introduced in Brazil in colorectal surgeries, and in elderly orthopedic femur fractures in 2010, with primary objective the return to independent life. The objective of this descriptive study was to evaluate the clinical results for ten years (2010-2019) after implantation of a perioperative acceleration protocol in 870 patients over 60 years of age undergoing surgical treatment of femoral fractures.

Methods: We studied a longitudinal prospective study in a patient over the 60 years old undergoing corrective hip fracture of both genders for ten years at a hospital covered by the Brazilian Public Health System (SUS). Information on the preoperative condition of these patients, abbreviation for fasting, hunger and thirst assessment, mode of anesthesia, drugs used, intra-operatively measured variables and immediate post-operative variables measured in the PACU, quality of lumbar plexus block analgesia, presence of delirium in the first day of postoperative was obtained from the study protocol and death in the first postoperative month.

Results: During the period of study 829 patients underwent surgery for a fracture of the hip, of whom 583 were women and 246 were men. Prior to injury, all the patients were living at home. The average hospital stay in all patients was 10.2±7.1 days, and there is an association between age and length of stay. The mean fasting time was 2:50±0:32 hours, and no significant difference between the three groups. All patients were submitted to spinal anesthesia. The dose ranged from 6 to 15 mg, with a mean of 9.62±1:85 mg isobaric bupivacaine. The cephalad dispersion varied between T12 and T5, in all patients, and the mode was the same T11 regardless of age group of patients. The duration of the spinal block was 2:50±0:38 hours, the time for the use of dextrinomaltose in PACU was 1:39±0:47 hours, the time in the PACU was 2:03±0:46 hours and the time to reintroduce normal meals were 6:18±1:02 hours. Arterial hypotension occurred in 36 (4.3%) patients, bradycardia in 4 (0.4%), and delirium in 16 patients. Of the 829 patients, only 11 (1.3%) were referred to the ICU due to surgical problems. There were no deaths directly related to anesthesia or surgery.

Conclusion: The implementation of the ACERTO Project in 829 patients with femur fracture of the Brazilian Public Health System, showed that there was a marked improvement in length of stay, patient satisfaction, decreased use of bladder tube and drains, and referral to ICU, with early discharge to residence. This study represents a decrease in the total cost, although this data has not been evaluated.

Keywords: Surgery; Orthopedic; Spinal anesthesia; Fasting; Perioperative care; Fast-track surgery; Elderly patient.

Key words: Surgery; Orthopedic; Spinal anesthesia; Fasting; Perioperative care; Fast-track surgery; Elderly patient.

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