PDF(Pubmed)
Abstract：
This study\'s aim is to describe the characteristics of perioperative acute cholecystitis in older patients with hip fracture.
From January 1, 2018, to April 30, 2023, 7,746 medical records were retrospectively collected for patients aged ≥ 65 years who were hospitalised for hip fracture in Beijing Jishuitan Hospital, Capital Medical University. We reviewed 10 cases with confirmed diagnoses of acute cholecystitis.
Of these 10 cases, five femoral neck fractures and five intertrochanteric fractures received orthopaedic surgery. The ratio of males to females was 2:8, the median age was 83.1 years (71-91 years), and there was a median BMI of 25.35 (15.56-35.16). 50% of cases had a poor functional capacity before fracture of below four metabolic equivalents. The median onset time of acute cholecystitis was five days (2-14 days) after fracture, including five cases before orthopaedic surgery and five cases after orthopaedic surgery. All patients had anorexia and fever during the course of the disease. In seven cases of calculous cholecystitis, two underwent percutaneous transhepatic biliary drainage, and one underwent percutaneous cholecystostomy. Two cases of calculous cholecystitis had poor prognosis; one died 49 days after fracture operation, and the reason for death was multiple organ failure caused by severe infection. The other one developed acute cerebellar infarction after gallbladder surgery through treatment in an intensive care unit and neurology department. The case was discharged with dysphasia, and the duration from fracture to discharge was 92 days.
This is the first study on the characteristics of acute cholecystitis in older patients with hip fracture in China. The incidence of acute cholecystitis in our study was 0.13%, with a high risk of in-hospital mortality and elevated hospitalisation costs. Our 10 cases with hip fractures accompanied by acute cholecystitis have common characteristics of poor-to-moderate functional capacity before fracture, increased blood glucose levels and enhanced protein metabolism after fracture. The death and the severe case have similar characteristics of low BMI, multiple underlying diseases, high plasma osmotic pressure and calculous cholecystitis, which occurred after orthopaedic surgery. These issues require attention and prompt, active intervention. Related issues require further research.
From January 1, 2018, to April 30, 2023, 7,746 medical records were retrospectively collected for patients aged ≥ 65 years who were hospitalised for hip fracture in Beijing Jishuitan Hospital, Capital Medical University. We reviewed 10 cases with confirmed diagnoses of acute cholecystitis.
Of these 10 cases, five femoral neck fractures and five intertrochanteric fractures received orthopaedic surgery. The ratio of males to females was 2:8, the median age was 83.1 years (71-91 years), and there was a median BMI of 25.35 (15.56-35.16). 50% of cases had a poor functional capacity before fracture of below four metabolic equivalents. The median onset time of acute cholecystitis was five days (2-14 days) after fracture, including five cases before orthopaedic surgery and five cases after orthopaedic surgery. All patients had anorexia and fever during the course of the disease. In seven cases of calculous cholecystitis, two underwent percutaneous transhepatic biliary drainage, and one underwent percutaneous cholecystostomy. Two cases of calculous cholecystitis had poor prognosis; one died 49 days after fracture operation, and the reason for death was multiple organ failure caused by severe infection. The other one developed acute cerebellar infarction after gallbladder surgery through treatment in an intensive care unit and neurology department. The case was discharged with dysphasia, and the duration from fracture to discharge was 92 days.
This is the first study on the characteristics of acute cholecystitis in older patients with hip fracture in China. The incidence of acute cholecystitis in our study was 0.13%, with a high risk of in-hospital mortality and elevated hospitalisation costs. Our 10 cases with hip fractures accompanied by acute cholecystitis have common characteristics of poor-to-moderate functional capacity before fracture, increased blood glucose levels and enhanced protein metabolism after fracture. The death and the severe case have similar characteristics of low BMI, multiple underlying diseases, high plasma osmotic pressure and calculous cholecystitis, which occurred after orthopaedic surgery. These issues require attention and prompt, active intervention. Related issues require further research.
摘要：
目的：本研究的目的是描述老年髋部骨折患者围手术期急性胆囊炎的特点。
方法：从2018年1月1日至2023年4月30日，回顾性收集北京积水潭医院因髋部骨折住院的年龄≥65岁患者的7,746份病历。首都医科大学。我们回顾了10例确诊为急性胆囊炎的病例。
结果：在这10例中，5例股骨颈骨折和5例股骨粗隆间骨折接受了骨科手术.男女比例为2:8，中位年龄为83.1岁（71-91岁），BMI中位数为25.35（15.56-35.16）。50％的病例在骨折前的功能能力差，低于四个代谢当量。急性胆囊炎的中位发病时间为骨折后5天(2-14天),其中骨科手术前5例,骨科手术后5例。所有患者在病程中都有厌食和发热。在7例结石性胆囊炎中，两名患者接受了经皮肝穿刺胆道引流术,其中一人接受了经皮胆囊造口术。2例结石性胆囊炎预后不良,1例骨折术后49天死亡,死亡原因是严重感染引起的多器官功能衰竭。另一例在重症监护病房和神经科进行胆囊手术后发展为急性小脑梗死。该病例因吞咽困难而出院,从骨折到出院的持续时间为92天。
结论：这是国内首次研究老年髋部骨折患者急性胆囊炎的特点。在我们的研究中，急性胆囊炎的发病率为0.13%，住院死亡率高，住院费用高。我们的10例髋部骨折伴急性胆囊炎患者具有骨折前功能差-中度的共同特征，骨折后血糖水平升高，蛋白质代谢增强。死亡和重症病例具有相似的低BMI特征，多种潜在疾病，高血浆渗透压和结石性胆囊炎，发生在骨科手术后。这些问题需要注意和迅速，积极干预。相关问题有待进一步研究。
方法：从2018年1月1日至2023年4月30日，回顾性收集北京积水潭医院因髋部骨折住院的年龄≥65岁患者的7,746份病历。首都医科大学。我们回顾了10例确诊为急性胆囊炎的病例。
结果：在这10例中，5例股骨颈骨折和5例股骨粗隆间骨折接受了骨科手术.男女比例为2:8，中位年龄为83.1岁（71-91岁），BMI中位数为25.35（15.56-35.16）。50％的病例在骨折前的功能能力差，低于四个代谢当量。急性胆囊炎的中位发病时间为骨折后5天(2-14天),其中骨科手术前5例,骨科手术后5例。所有患者在病程中都有厌食和发热。在7例结石性胆囊炎中，两名患者接受了经皮肝穿刺胆道引流术,其中一人接受了经皮胆囊造口术。2例结石性胆囊炎预后不良,1例骨折术后49天死亡,死亡原因是严重感染引起的多器官功能衰竭。另一例在重症监护病房和神经科进行胆囊手术后发展为急性小脑梗死。该病例因吞咽困难而出院,从骨折到出院的持续时间为92天。
结论：这是国内首次研究老年髋部骨折患者急性胆囊炎的特点。在我们的研究中，急性胆囊炎的发病率为0.13%，住院死亡率高，住院费用高。我们的10例髋部骨折伴急性胆囊炎患者具有骨折前功能差-中度的共同特征，骨折后血糖水平升高，蛋白质代谢增强。死亡和重症病例具有相似的低BMI特征，多种潜在疾病，高血浆渗透压和结石性胆囊炎，发生在骨科手术后。这些问题需要注意和迅速，积极干预。相关问题有待进一步研究。
