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Factores pronósticos de buena funcionalidad a los 12 meses, de una fractura de cadera. Estudio Maluc Anoia
Pronostic factors of good functionality at 12 months of a hip fracture. Maluc Anoia study
A. Gamboa-Arangoa,
Autor para correspondencia
agamboa@csa.cat

Autor para correspondencia.
, E. Duasoa, F. Formigab, P. Marimónc, M. Sandiumengea, M.T. Salgadod, E. Escalantea, C. Lumbrerasa, A. Tarridaa
a Unidad Geriátrica de Agudos, Servicio de Geriatría, Hospital de Igualada, Igualada, España
b Programa de Geriatría, Medicina Interna, Hospital Universitario de Bellvitge, IDIBELL, L’Hospitalet de Llobregat, España
c Unidad Geriátrica de Agudos, Servicio de Traumatología y Cirugía Ortopédica, Hospital de Igualada, Igualada, España
d Servicio de Fisioterapia, Fundación Sanitaria San José, Igualada, España
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e incluso puede incrementarse hasta el 40&#37; en los siguientes 2 a&#241;os<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">4&#8211;9</span></a>&#46; Adem&#225;s&#44; la fractura de cadera es un condicionante de deterioro funcional que a menudo precipita en la institucionalizaci&#243;n del paciente y conlleva elevados costes econ&#243;micos<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">4&#44;5</span></a>&#46; Uno de los objetivos de la ortogeriatr&#237;a es lograr que los pacientes&#44; despu&#233;s de una fractura de f&#233;mur&#44; consigan volver a su domicilio habitual preservando el m&#225;ximo grado de independencia f&#237;sica y cognitiva&#44; a lo largo del m&#225;ximo de tiempo posible&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Por este motivo&#44; el objetivo de nuestro estudio es identificar los factores pron&#243;sticos que permitan el mantenimiento funcional a los 12 meses de una fractura de cadera por fragilidad &#243;sea &#40;FCFO&#41;&#44; despu&#233;s de haber sido atendidos en una unidad geri&#225;trica de agudos&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materiales y m&#233;todos</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Dise&#241;o del estudio y participantes</span><p id="par0015" class="elsevierStylePara elsevierViewall">Se trata de un estudio prospectivo realizado en el Hospital de Igualada&#44; con un &#225;rea de influencia de 118&#46;467 habitantes correspondientes a la Comarca de la Anoia &#40;Barcelona&#41;&#46; Los criterios de inclusi&#243;n han sido&#58; pacientes mayores de 69 a&#241;os procedentes de domicilio con FCFO&#44; ingresados en la Unidad Geri&#225;trica de agudos desde urgencias&#44; dentro de un periodo de 36 meses&#44; y que hayan dado su consentimiento verbal &#40;en caso de demencia&#44; el familiar responsable y&#47;o tutor&#41; a participar en este estudio&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Los pacientes de la muestra&#44; reclutados de forma prospectiva&#44; han recibido una intervenci&#243;n en que la gesti&#243;n asistencial de todo el proceso recae en el equipo interdisciplinar de geriatr&#237;a&#46; Esta intervenci&#243;n est&#225; enmarcada dentro de la Gu&#237;a Terap&#233;utica de la Fractura de Cadera del Hospital de Igualada&#44; la cual se ha descrito previamente<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">10</span></a> y que en la actualidad est&#225; actualizada en relaci&#243;n con la bibliograf&#237;a&#59; los aspectos m&#225;s relevantes no han cambiado con respecto a lo mencionado en la referencia de Duaso et al&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">10</span></a> como son&#58; estancia en urgencias<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>3<span class="elsevierStyleHsp" style=""></span>h&#44; intervenci&#243;n quir&#250;rgica antes de las 48<span class="elsevierStyleHsp" style=""></span>h e ingreso directo desde urgencias a la Unidad Geri&#225;trica de Agudos&#44; entre otros&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Se han recogido la siguientes variables&#58; demogr&#225;ficas &#40;sexo&#44; edad&#44; estado civil&#44; lugar de procedencia&#44; destino al alta&#41;&#44; de funcionalidad previa al ingreso y al alta &#40;&#237;ndice Barthel &#91;IB&#93;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">11</span></a>&#44; &#237;ndice Lawton y Brody<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">12</span></a>&#44; de ejecuci&#243;n de la marcha previa al ingreso y al alta &#40;Functional Ambulation Classification&#41;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">13</span></a>&#44; de estado cognitivo &#40;Geriatric Dementia Scale &#40;GDS&#41;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">14</span></a>&#59; &#237;ndice de comorbilidad de Charlson<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">15</span></a>&#44; par&#225;metros bioqu&#237;micos &#40;funci&#243;n renal&#44; TSH&#44; calcio&#44; prote&#237;nas&#44; albumina&#41;&#46; Tambi&#233;n sobre el tiempo de espera quir&#250;rgico&#44; la localizaci&#243;n de la fractura&#44; el riesgo anest&#233;sico &#40;clasificaci&#243;n American Society Anesthesiologist &#91;ASA&#93;&#41;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">16</span></a>&#59; tiempo de estancia hospitalaria&#44; la presencia o no de <span class="elsevierStyleItalic">delirium</span> durante el ingreso&#44; complicaciones durante el ingreso &#40;infecciosas&#44; anemia con requerimiento transfusional&#44; alteraciones hidroelectrol&#237;ticas&#44; descompensaci&#243;n cardiovascular&#41;&#44; alteraciones sensoriales&#44; y la presencia de medicamentos asociados potencialmente a las ca&#237;das&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Con el objetivo de conocer los factores pron&#243;sticos de mantener funcionalidad a los 12 meses&#44; hemos divido la muestra en 2 grupos&#59; un primer grupo de mantenimiento funcional a los 12 meses que consideramos como aquellos pacientes que han perdido entre 0-15 puntos en el IB con respecto al IB previo a la fractura y un segundo grupo denominado de p&#233;rdida funcional a los 12 meses&#58; aquellos pacientes que han perdido 20&#44; o m&#225;s&#44; puntos en el IB con respecto al previo a la fractura&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Este estudio ha sido aprobado por el Comit&#233; de &#201;tica del Hospital de Bellvitge &#40;PR197&#47;13&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">An&#225;lisis estad&#237;stico</span><p id="par0040" class="elsevierStylePara elsevierViewall">Para el an&#225;lisis estad&#237;stico se ha utilizado el programa estad&#237;stico SPSS versi&#243;n 19&#46;0 &#40;IBM Corporation&#44; Chicago Ilinois&#41;&#46; Se ha realizado un an&#225;lisis estad&#237;stico bivariado&#44; con la intenci&#243;n de identificar los factores relacionados con las variables estudiadas&#46; En este an&#225;lisis&#44; para estudiar la relaci&#243;n entre una variable num&#233;rica y una categ&#243;rica se ha utilizado la prueba U de Mann-Whitney&#46; Para estudiar la relaci&#243;n entre variables categ&#243;ricas se ha empleado la prueba Chi cuadrado&#44; con la correcci&#243;n del test de Fisher&#46; Las variables que en el an&#225;lisis bivariado han mostrado una relaci&#243;n estad&#237;sticamente significativa&#44; se han incluido en un modelo de an&#225;lisis multivariado de regresi&#243;n log&#237;stica binaria y se han eliminado las variables que no han presentado significaci&#243;n estad&#237;stica &#40;siempre y cuando no hayan sido factores de confusi&#243;n&#41;&#44; con la finalidad de obtener un modelo &#243;ptimo de predicci&#243;n de las variables estudiadas&#46; La capacidad discriminatoria del modelo se ha evaluado con el &#225;rea bajo la curva y la calibraci&#243;n del modelo con el test de Hasmer-Lemeshow&#46; En todos los an&#225;lisis se ha considerado estad&#237;sticamente significativo valores de p<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46;</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Resultados</span><p id="par0045" class="elsevierStylePara elsevierViewall">Durante el periodo de estudio se han ingresado 371 pacientes con diagn&#243;stico de FCFO&#59; 5 &#40;1&#44;3&#37;&#41; de los cuales han fallecido durante el ingreso hospitalario&#46; Se han analizado 366 pacientes dados de alta de la Unidad Geri&#225;trica de Agudos&#46; En el seguimiento a los 12 meses&#44; se han excluido los 95 &#40;25&#44;9&#37;&#41; fallecimientos acaecidos&#46; Las caracter&#237;sticas generales in&#237;ciales de los 371 pacientes&#44; finalmente incluidos en la poblaci&#243;n inicial de estudio&#44; las encontramos en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Factores pron&#243;sticos de mantenimiento de la funcionalidad a los 12 meses despu&#233;s de la fractura de cadera</span><p id="par0050" class="elsevierStylePara elsevierViewall">En 148 &#40;54&#44;8&#37;&#41; pacientes con una edad media de 83&#44;40 a&#241;os y con una proporci&#243;n de mujeres del 55&#44;6&#37;&#44; se mantiene la funcionalidad y&#44; por el contrario&#44; en 122 pacientes &#40;45&#44;2&#37;&#41; con una edad media de 85&#44;80 a&#241;os y una proporci&#243;n de mujeres del 44&#44;4&#37; no&#46; La comparativa entre los 2 grupos se muestra en la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#46; Destacan como factores relacionados con el mantenimiento de funcionalidad a los 12 meses una menor edad &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#41;&#59; una mejor puntuaci&#243;n del &#237;ndice Lawton y Brody &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#59; una mejor puntaci&#243;n del IB alta &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#41;&#59; una mejor puntuaci&#243;n en el GDS &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;009&#41;&#59; un menor riesgo quir&#250;rgico seg&#250;n la clasificaci&#243;n ASA&#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;006&#41;&#59; el no haber presentado <span class="elsevierStyleItalic">delirium</span> durante el ingreso &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#41; <span class="elsevierStyleItalic">y</span> el no tener diagn&#243;stico de demencia previo a la fractura &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;046&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">Las variables que mantienen su significaci&#243;n estad&#237;stica en el an&#225;lisis multivariado son el tener menor edad OR&#58; 1&#44;044 &#40;IC 95&#37;&#58; 1&#44;002-1&#44;088&#41; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;042&#41; y el incremento en la puntuaci&#243;n en el &#237;ndice Lawton y Brody OR&#58; 0&#44;869 &#40;IC 95&#37;&#58; 0&#44;804-0&#44;940&#41; &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; con una capacidad de discriminaci&#243;n del modelo AUC &#40;&#177;<span class="elsevierStyleHsp" style=""></span>IC 95&#37;&#41;&#58; 0&#44;658&#46; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discusi&#243;n</span><p id="par0060" class="elsevierStylePara elsevierViewall">Los distintos estudios de pacientes con FCFO utilizan diversas y heterog&#233;neas medidas para determinar el mantenimiento funcional&#46; Adem&#225;s&#44; en dichos estudios&#44; la funcionalidad no se valora en los mismos periodos de tiempo posterior a la fractura&#44; ni en los mismos niveles de funcionalidad previa<a class="elsevierStyleCrossRefs" href="#bib0305"><span class="elsevierStyleSup">17&#44;18</span></a>&#44; lo que evidencia una disparidad de datos y resultados en relaci&#243;n con el mantenimiento de la funcionalidad&#46; Se ha considerado que las variaciones de 20 puntos en el IB tienen relaci&#243;n con diferentes resultados en salud&#59; entre ellos la capacidad funcional<a class="elsevierStyleCrossRefs" href="#bib0315"><span class="elsevierStyleSup">19&#44;20</span></a>&#46; Es por ello que hemos decidido elegir este valor como referencia al medir el mantenimiento de la funcionalidad a los 12 meses tras la FCFO&#44; en el global de los 271 pacientes estudiados&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Es importante resaltar que el mantenimiento funcional se debe&#44; de manera muy importante&#44; a un adecuado proceso de recuperaci&#243;n funcional posterior a la fractura&#44; donde los programas de rehabilitaci&#243;n&#44; bien sean en unidades de rehabilitaci&#243;n&#44; bien en programas de rehabilitaci&#243;n domiciliaria&#44; han demostrado ser eficaces<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">21&#8211;23</span></a>&#46; Independientemente de ello&#44; nuestro objetivo es identificar aquellos factores pron&#243;sticos que&#44; junto con la rehabilitaci&#243;n&#44; estar&#237;an involucrados en el mantenimiento funcional&#44; a los 12 meses tras la FCFO&#44; de los 271 pacientes estudiados&#59; tuvieran buena&#44; media o mala funcionalidad previa a la FCFO con relaci&#243;n a las actividades de la vida diaria&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">De los pacientes que sobreviven a una FCFO al a&#241;o de la misma&#44; menos del 80&#37;&#44; con buena funcionalidad previa<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">17</span></a>&#44; son los que mantienen la funcionalidad&#46; En nuestro estudio mantienen la funcionalidad previa el 54&#44;8&#37;&#46; No deja de ser un muy buen resultado al tratarse&#44; en este caso&#44; de todos los pacientes vivos a los 12 meses de la FCFO&#44; tuvieran buena&#44; media o mala funcionalidad previa&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Al igual que en otros estudios similares<a class="elsevierStyleCrossRefs" href="#bib0305"><span class="elsevierStyleSup">17&#44;20&#44;24&#8211;28</span></a>&#44; los factores pron&#243;sticos relacionados con el mantenimiento funcional a los 12 meses de la FCFO&#44; adem&#225;s de la edad m&#225;s joven&#44; ser&#237;an aquellos relacionados con un buen estado de salud previo a la fractura&#46; Es as&#237; como los resultados del presente estudio est&#225;n en concordancia con el estudio realizado por Fukui et al&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">24</span></a>&#44; con similitudes respecto a la edad&#44; al estado de salud previo y a la mayor independencia en las actividades de la vida diaria&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Referente a la ejecuci&#243;n en las actividades de la vida diaria&#44; si bien Fukui et al&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">24</span></a> destacan como fuerte predictor de mantenimiento funcional la independencia en el ba&#241;o como actividad de la vida diaria&#44; &#237;tem incluido en el IB&#44; en nuestro caso evaluamos el IB de manera global&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">En referencia a la demencia&#44; en los criterios diagn&#243;sticos &#40;DSM-V y NIA-AA&#41;<a class="elsevierStyleCrossRefs" href="#bib0365"><span class="elsevierStyleSup">29&#44;30</span></a> se incluyen la dependencia en la ejecuci&#243;n de actividades de la vida diaria&#46; As&#237; el diagn&#243;stico de demencia&#44; sabiendo que con la edad se incrementa su prevalencia<a class="elsevierStyleCrossRefs" href="#bib0375"><span class="elsevierStyleSup">31&#44;32</span></a>&#44; y su grado de severidad&#44; es factor asociado a la p&#233;rdida funcional posterior a la FCFO<a class="elsevierStyleCrossRefs" href="#bib0310"><span class="elsevierStyleSup">18&#44;25&#44;28</span></a>&#46; En el presente estudio la ausencia de demencia&#44; en los pacientes m&#225;s j&#243;venes&#44; se relaciona con el mantenimiento funcional durante el seguimiento&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">En referencia al <span class="elsevierStyleItalic">delirium&#44;</span> Vochteloo et al&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">26</span></a> refieren que cerca del 50&#37; de los pacientes con FCFO no mantienen su movilidad al a&#241;o de seguimiento&#46; En su modelo&#44; el <span class="elsevierStyleItalic">delirium</span> y la dependencia para las actividades b&#225;sicas de la vida diaria son los factores predictores de no mantener la movilidad previa a la FCFO&#46; En nuestro modelo&#44; la ausencia de <span class="elsevierStyleItalic">delirium</span> &#40;s&#237;ndrome geri&#225;trico asociado a mal pron&#243;stico&#41;<a class="elsevierStyleCrossRefs" href="#bib0385"><span class="elsevierStyleSup">33&#44;34</span></a> y la independencia para las actividades de la vida diaria han sido un factor de gran relevancia asociado al mantenimiento de la funcionalidad a los 12 meses de la FCFO&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Finalmente en nuestro modelo&#44; de atenci&#243;n multidisciplinar&#44; el corto periodo de espera quir&#250;rgica&#44; junto con el inicio precoz de la fisioterapia y la terapia ocupacional&#44; posiblemente sean los factores determinantes para el grado de recuperaci&#243;n funcional al alta&#44; que a su vez ha sido uno de los factores asociados al mantenimiento de la funcionalidad a los 12 meses&#46; Es importante destacar que los pacientes con mayor independencia en las actividades de la vida diaria al alta obtienen mejores resultados a los 12 meses de seguimiento&#59; resultado similar al observado en la revisi&#243;n sistem&#225;tica conducida por Lim et al&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">18</span></a>&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Ser&#237;a posible que la promoci&#243;n y obtenci&#243;n de un mayor nivel de independencia en las actividades de la vida diaria al alta&#44; junto con la prevenci&#243;n y la detecci&#243;n precoz del <span class="elsevierStyleItalic">delirium</span>&#44; sean los &#250;nicos factores que podr&#237;amos considerar modificables&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Los resultados obtenidos en el presente estudio apoyan las recomendaciones actuales para la atenci&#243;n de los pacientes mayores con FCFO&#44; evidenciando c&#243;mo el manejo pre- y postoperatorio de estos pacientes&#44; en unidades ortogeri&#225;tricas&#44; mejora los resultados asistenciales a corto y mediano plazo<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">4&#44;35&#8211;44</span></a>&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Las fortalezas de nuestro estudio son&#58; el haberse realizado en una Unidad Geri&#225;trica de Agudos&#59; la muestra obtenida es una clara representaci&#243;n de los pacientes geri&#225;tricos&#44; precisamente aquellos que m&#225;s necesitan de un intervenci&#243;n en unidades especializadas que se adapten a sus necesidades&#46; Asimismo evidenciamos como principales limitaciones que nuestro estudio tiene un dise&#241;o observacional y unic&#233;ntrico&#46; Otras limitaciones podr&#237;an ser la ausencia de seguimiento presencial y el no recolectar eventos intermedios durante el seguimiento&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conclusiones</span><p id="par0115" class="elsevierStylePara elsevierViewall">En nuestro modelo hemos encontrado que los factores pron&#243;sticos predictores de mantenimiento funcional a los 12 meses de una FCFO son la menor edad y la mejor capacidad de ejecuci&#243;n de las actividades instrumentales de la vida diaria&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Nuestros resultados son de especial relevancia&#44; dado que nos permiten identificar a aquellos pacientes con posible riesgo de p&#233;rdida de funcionalidad y&#44; de esta manera&#44; poder intervenir en aquellos factores que puedan ser modificables&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">La realizaci&#243;n de un ensayo cl&#237;nico aleatorizado multic&#233;ntrico permitir&#237;a la validaci&#243;n de los resultados de este estudio as&#237; como la de otros&#44; refrendando los resultados favorables de las unidades ortogeri&#225;tricas&#44; como un modelo validado para la atenci&#243;n integral del paciente mayor con FCFO&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Nivel de evidencia</span><p id="par0130" class="elsevierStylePara elsevierViewall">Nivel de evidencia III</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Financiaci&#243;n</span><p id="par0135" class="elsevierStylePara elsevierViewall">La presente investigaci&#243;n no ha recibido ninguna beca espec&#237;fica de agencias de los sectores p&#250;blico&#44; comercial&#44; o sin &#225;nimo de lucro</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflicto de intereses</span><p id="par0140" class="elsevierStylePara elsevierViewall">Los autores declaran no tener conflicto de intereses al realizar este estudio&#46;</p></span></span>"
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            0 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Factores pron&#243;sticos de mantenimiento de la funcionalidad a los 12 meses despu&#233;s de la fractura de cadera"
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          "titulo" => "Nivel de evidencia"
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          "titulo" => "Financiaci&#243;n"
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          "titulo" => "Conflicto de intereses"
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          "identificador" => "xack446826"
          "titulo" => "Agradecimientos"
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        13 => array:1 [
          "titulo" => "Bibliograf&#237;a"
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    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2019-04-15"
    "fechaAceptado" => "2019-06-11"
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          "identificador" => "xpalclavsec1198546"
          "palabras" => array:4 [
            0 => "Fractura de cadera"
            1 => "Unidad Geri&#225;trica Agudos"
            2 => "Adulto mayor"
            3 => "Factores pron&#243;sticos"
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            0 => "Hip fracture"
            1 => "Acute Geriatric Unit"
            2 => "Older adult"
            3 => "Prognostic factors"
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Antecedentes</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La fractura de cadera suele ocurrir en pacientes fr&#225;giles de edad avanzada y va asociada a una importante morbimortalidad al al primer a&#241;o&#46; El objetivo del estudio es describir los factores pron&#243;sticos que permitir&#237;an mantener la funcionalidad a los 12 meses&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">M&#233;todo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Desde el 1 de junio de 2010 hasta el 31 de mayo de 2013 se han incluido a todos los pacientes mayores de 69 a&#241;os con fractura de cadera por fragilidad &#243;sea ingresados en la Unidad Geri&#225;trica de Agudos de nuestro hospital&#46; Definimos como mantenimiento funcional a aquellos pacientes que han perdido entre 0-15 puntos en el &#237;ndice de Barthel respecto al previo a la fractura&#46; Estudio prospectivo de an&#225;lisis de datos bivariado para los factores pron&#243;sticos relacionados y multivariado para los factores pron&#243;sticos predictores&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se incluyen 271 pacientes&#44; de ellos&#44; 146 &#40;54&#44;8&#37;&#41;&#44; mantienen funcionalidad a los 12 meses y 122 &#40;45&#44;2&#37;&#41; no&#46; Los pacientes que mantienen el estado funcional son m&#225;s j&#243;venes&#58; edad media 83&#44;4 vs&#46; 85&#44;80 a&#241;os &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#41;&#59; con mejores puntaciones en los &#237;ndices de&#58; Lawton previo a la fractura 4&#44;42 vs&#46; 2&#44;40 &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; y Barthel al alta 34&#44;2 vs&#46; 27&#44;1 &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#41;<span class="elsevierStyleItalic">&#46;</span> Tambi&#233;n hay diferencias en la puntuaci&#243;n de la &#171;Geriatric Dementia Scale&#187; 2&#44;59 vs&#46; 3&#44;13 &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;009&#41;&#44; en la puntuaci&#243;n de la &#171;American Society Anesthesiologist&#187;<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>II 62&#44;2 vs&#46; 37&#44;8&#37; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;006&#41; y han presentado menos <span class="elsevierStyleItalic">delirium</span> durante la hospitalizaci&#243;n 4&#44;7 vs&#46; 35&#44;3&#37; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#41;&#46; En el an&#225;lisis multivariado han mantenido significaci&#243;n estad&#237;stica&#44; la edad OR&#58; 1&#44;044 &#40;IC 95&#37;&#58; 1&#44;002-1&#44;088&#41; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;04&#41; y el &#237;ndice de Lawton OR&#58; 0&#44;869 &#40;IC 95&#37;&#58; 0&#44;804-0&#44;940&#41; &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Los factores pron&#243;sticos de mantenimiento funcional a los 12 meses son la edad y la capacidad de realizar actividades instrumentales de la vida diaria&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Antecedentes"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "M&#233;todo"
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          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Resultados"
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          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusiones"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Background</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Hip fracture usually occurs in frail elderly patients and is associated with an important morbi-mortality in the first year&#46; The objective of the study is to describe the prognostic factors that would allow maintaining functionality at 12 months&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Method</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">From June 1&#44; 2010 to May 31&#44; 2013&#44; all patients older than 69 years with hip fracture due to bone fragility admitted to the Geriatric Acute Unit of our hospital were included&#46; We define as functional maintenance those patients who have lost between 0-15 points in the Barthel Index with respect to the previous to the fracture&#46; Prospective study of bivariate data analysis for related and multivariate prognostic factors for predictive predictors&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">271 patients were included&#44; of them&#44; 146 &#40;54&#46;8&#37;&#41;&#44; maintained functionality at 12 months and 122 &#40;45&#46;2&#37;&#41; no&#46; Patients who maintain functional status are younger&#58; average age 83&#46;4 vs 85&#46;80 years &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;002&#41;&#59; with better scores in the indexes of&#58; Lawton prior to fracture 4&#46;42 vs 2&#46;40 &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41; and Barthel at discharge 34&#46;2 vs&#46; 27&#46;1 &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;002&#41;&#46; There are also differences in the score of the &#8220;Geriatric Dementia Scale&#8221; 2&#46;59 vs&#46; 3&#46;13 &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;009&#41;&#44; in the score of the &#8220;American Society Anesthesiologist&#8221;<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>II 62&#46;2&#37; vs 37&#46;8&#37; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;006&#41; and have presented less delirium during hospitalization 4&#46;7&#37; vs 35&#46;3&#37; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;002&#41;&#46; In the multivariate analysis they maintained statistical significance&#44; age OR&#58; 1&#46;044 &#40;95&#37; CI&#58; 1&#46;002-1&#46;088&#41; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;04&#41; and the Lawton Index OR&#58; 0&#46;869 &#40;95&#37; CI&#58; 0&#46;804-0&#46;940&#41; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span> &#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Prognostic factors of functional maintenance at 12 months are age and the ability to perform instrumental activities of daily life&#46;</p></span>"
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            "titulo" => "Background"
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            "identificador" => "abst0035"
            "titulo" => "Results"
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            "identificador" => "abst0040"
            "titulo" => "Conclusions"
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                  \t\t\t\t">84&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#44;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Femenino&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">85&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#44;4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Masculino&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Femenino&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">297 &#40;80&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Viudo&#47;a&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">135 &#40;60&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Casado&#47;a&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">66 &#40;29&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">24 &#40;10&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#205;ndice Barthel basal&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">73<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>28&#44;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Centro sociosanitario&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2 &#40;28&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#205;ndice de Barthel basal&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;298&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#205;ndice de Barthel de ingreso&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">18&#44;83<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#44;90&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">15&#44;69<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#44;88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;102&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#205;ndice de Barthel de alta&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">34&#44;21<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>18&#44;55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">27&#44;10<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&#44;81&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Functional Ambulation Classification basal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4&#44;21<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;40&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4&#44;48<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;829&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Functional Ambulation Classification de alta&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#44;03<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;65&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;74 <span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;61&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;318&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Funcionalidad Cognitiva basal &#40;Graus GDS de Reisberg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;59<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;15&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;13<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;95&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Comorbilidad</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#205;ndice de Charlson&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;90<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;14<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;074&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Polifarmacia antes de la fractura de cadera</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>4 f&#225;rmacos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">107 &#40;53&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">94 &#40;46&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;357&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>4 f&#225;rmacos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40 &#40;59&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27 &#40;40&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Localizaci&#243;n de la fractura</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Intracapsular&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">64 &#40;62&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">39 &#40;37&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;058&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Extracapsular&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">84 &#40;50&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">83 &#40;49&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Riesgo anest&#233;sico</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>ASA<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>II&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">97 &#40;62&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">59 &#40;37&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;006&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>ASA<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">50 &#40;45&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">61 &#40;55&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Tiempo de espera quir&#250;rgico</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>D&#237;as&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;67 &#177; 0&#44;95&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;74 &#177; 0&#44;98&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;249&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Deterioro cognitivo &#40;demencia&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Par&#225;metros bioqu&#237;micos</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tasa de filtraci&#243;n glomerular<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>60 &#40;MDRD&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Alb&#250;mina<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>35&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hb<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>13<span class="elsevierStyleHsp" style=""></span>M y &#60;<span class="elsevierStyleHsp" style=""></span>12<span class="elsevierStyleHsp" style=""></span>W&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Complicaciones intrahospitalarias</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Anemia que requiere de transfusi&#243;n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cardiol&#243;gicas&#47;Respiratorias&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hidroelectrol&#237;ticas&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Infecciosas&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Delirium</span>&nbsp;\t\t\t\t\t\t\n
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