As fraturas do quadril têm um risco de mortalidade de aproximadamente 30% em 1 ano, e 25% a 75% dos adultos residentes na comunidade podem não recuperar seu nível de função pré-fratura.[31]North American Menopause Society. Management of osteoporosis in postmenopausal women: the 2021 position statement of the North American Menopause Society. Menopause. 2021 Sep 1;28(9):973-97.
http://www.ncbi.nlm.nih.gov/pubmed/34448749?tool=bestpractice.com
[124]Magaziner J, Simonsick EM, Kashner TM, et al. Predictors of functional recovery one year following hospital discharge for hip fracture: a prospective study. J Gerontol. 1990 May;45(3):M101-7.
http://www.ncbi.nlm.nih.gov/pubmed/2335719?tool=bestpractice.com
[125]Fredman L, Hawkes WG, Black S, et al. Elderly patients with hip fracture with positive affect have better functional recovery over 2 years. J Am Geriatr Soc. 2006 Jul;54(7):1074-81.
http://www.ncbi.nlm.nih.gov/pubmed/16866678?tool=bestpractice.com
[126]Thorngren KG. Fractures in the elderly. Acta Orthop Scand Suppl. 1995 Oct;266:208-10.
http://www.ncbi.nlm.nih.gov/pubmed/8553854?tool=bestpractice.com
[127]Thorngren KG. Fractures in older persons. Disabil Rehabil. 1994 Jul-Sep;16(3):119-26.
http://www.ncbi.nlm.nih.gov/pubmed/7919395?tool=bestpractice.com
[128]Borgquist L, Ceder L, Thorngren KG. Function and social status 10 years after hip fracture. Prospective follow-up of 103 patients. Acta Orthop Scand. 1990 Oct;61(5):404-10.
http://www.ncbi.nlm.nih.gov/pubmed/2239162?tool=bestpractice.com
[129]Marottoli RA, Berkman LF, Cooney LM Jr. Decline in physical function following hip fracture. J Am Geriatr Soc. 1992 Sep;40(9):861-6.
http://www.ncbi.nlm.nih.gov/pubmed/1512379?tool=bestpractice.com
No entanto, para alguns dos pacientes mais vulneráveis com fratura do quadril (ou seja, residentes de instituições asilares), a mortalidade a 6 meses chega a 36% (e 46% para homens).[17]American Academy of Orthopaedic Surgeons. Management of hip fractures in older adults: evidence-based clinical practice guideline. December 2021 [internet publication].
https://www.aaos.org/globalassets/quality-and-practice-resources/hip-fractures-in-the-elderly/hipfxcpg.pdf
Os preditores de mortalidade incluem comorbidade significativa, função cognitiva pré-lesão baixa, eletrocardiograma (ECG) pré-operatório anormal, idade >85 anos e mobilidade pré-fratura diminuída.[130]Marottoli RA, Berkman LF, Leo-Summers L, et al. Predictors of mortality and institutionalization after hip fracture: the New Haven EPESE (Established Populations for Epidemiologic Studies of the Elderly) cohort. Am J Public Health. 1994 Nov;84(11):1807-12.
http://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.84.11.1807
http://www.ncbi.nlm.nih.gov/pubmed/7977922?tool=bestpractice.com
[131]Smith T, Pelpola K, Ball M, et al. Pre-operative indicators for mortality following hip fracture surgery: a systematic review and meta-analysis. Age Ageing. 2014 Jul;43(4):464-71.
https://academic.oup.com/ageing/article/43/4/464/2812257/Pre-operative-indicators-for-mortality-following
http://www.ncbi.nlm.nih.gov/pubmed/24895018?tool=bestpractice.com
Metanálises sugeriram que a cirurgia precoce está associada à taxa reduzida de mortalidade e complicações.[63]Simunovic N, Devereaux PJ, Sprague S, et al. Effect of early surgery after hip fracture on mortality and complications: systematic review and meta-analysis. CMAJ. 2010 Oct 19;182(15):1609-16.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2952007
http://www.ncbi.nlm.nih.gov/pubmed/20837683?tool=bestpractice.com
[64]Moja L, Piatti A, Pecoraro V, et al. Timing matters in hip fracture surgery: patients operated within 48 hours have better outcomes - a meta-analysis and meta-regression of over 190,000 patients. PLoS One. 2012;7(10):e46175.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3463569
http://www.ncbi.nlm.nih.gov/pubmed/23056256?tool=bestpractice.com
Os pacientes com afeto positivo que estão com boa saúde e moram com alguém têm melhor prognóstico.[124]Magaziner J, Simonsick EM, Kashner TM, et al. Predictors of functional recovery one year following hospital discharge for hip fracture: a prospective study. J Gerontol. 1990 May;45(3):M101-7.
http://www.ncbi.nlm.nih.gov/pubmed/2335719?tool=bestpractice.com
[128]Borgquist L, Ceder L, Thorngren KG. Function and social status 10 years after hip fracture. Prospective follow-up of 103 patients. Acta Orthop Scand. 1990 Oct;61(5):404-10.
http://www.ncbi.nlm.nih.gov/pubmed/2239162?tool=bestpractice.com
Idade avançada, fragilidade e aumento da estadia hospitalar resultam em prognóstico e desfecho inferiores em relação ao retorno para o estado funcional anterior à fratura.[124]Magaziner J, Simonsick EM, Kashner TM, et al. Predictors of functional recovery one year following hospital discharge for hip fracture: a prospective study. J Gerontol. 1990 May;45(3):M101-7.
http://www.ncbi.nlm.nih.gov/pubmed/2335719?tool=bestpractice.com
[132]van de Ree CLP, Landers MJF, Kruithof N, et al. Effect of frailty on quality of life in elderly patients after hip fracture: a longitudinal study. BMJ Open. 2019 Jul 18;9(7):e025941.
https://www.doi.org/10.1136/bmjopen-2018-025941
http://www.ncbi.nlm.nih.gov/pubmed/31324679?tool=bestpractice.com
Um estudo de coorte retrospectivo mostrou que os residentes de instituições asilares com fratura do quadril e demência avançada tiveram uma taxa de mortalidade mais baixa quando tratados de maneira cirúrgica, comparados com aqueles tratados não cirurgicamente, ressaltando a necessidade de equilibrar os desfechos esperados, as metas de cuidados do paciente e as comorbidades.[133]Berry SD, Rothbaum RR, Kiel DP, et al. Association of Clinical Outcomes With Surgical Repair of Hip Fracture vs Nonsurgical Management in Nursing Home Residents With Advanced Dementia. JAMA Intern Med. 2018 Jun 1;178(6):774-780.
https://www.doi.org/10.1001/jamainternmed.2018.0743
http://www.ncbi.nlm.nih.gov/pubmed/29801122?tool=bestpractice.com