Abstract：
BACKGROUND: Surgical treatment of hip fractures leads to significant post-operative complications. Although pathologic fractures (PF) are associated with worse outcomes, most studies do not differentiate between etiology (neoplastic and non-neoplastic PF). We seek to compare 30-day complication rates between 1) native hip fractures and neoplastic PF, and 2) neoplastic and non-neoplastic PF.
METHODS: A total of 127,819 patients with hip fractures and 5104 with PF diagnosed from 2005 to 2021 were retrieved from the NSQIP database. We included 1843 patients with neoplastic PF and 3261 with non-neoplastic PF. Demographics, pre-operative labs and co-morbidities, and post-operative outcomes were analyzed. Propensity-score matching was conducted to control for confounders.
RESULTS: Patients with a neoplastic PF had a significantly higher rate of deep venous thrombosis (DVT) (4 % vs 1.2 %, p = 0.001) and pulmonary embolism (PE) (2.4 % vs 0.7 %, p < 0.001), than native hip fractures. Rates of post-operative bleeding were significantly higher in the neoplastic PF group (29.3 % vs 23.9 %, p < 0.001) than non-neoplastic PF. No differences in soft tissue complications were found. When comparing neoplastic and non-neoplastic PF, the former had a higher rate of PE (2.5 % vs 1.0 %, p = 0.015) and post-operative bleeding (27.6 % vs 22.0 %, p = 0.009). Unplanned readmission rates and 30-day mortality rate were also higher in the neoplastic PF group.
CONCLUSIONS: Neoplastic PF of the hip are associated with higher risk of thromboembolic event rates and post-operative bleeding than both native hip fractures and non-neoplastic PF. No differences in rates of soft tissue complications were found between groups.
METHODS: A total of 127,819 patients with hip fractures and 5104 with PF diagnosed from 2005 to 2021 were retrieved from the NSQIP database. We included 1843 patients with neoplastic PF and 3261 with non-neoplastic PF. Demographics, pre-operative labs and co-morbidities, and post-operative outcomes were analyzed. Propensity-score matching was conducted to control for confounders.
RESULTS: Patients with a neoplastic PF had a significantly higher rate of deep venous thrombosis (DVT) (4 % vs 1.2 %, p = 0.001) and pulmonary embolism (PE) (2.4 % vs 0.7 %, p < 0.001), than native hip fractures. Rates of post-operative bleeding were significantly higher in the neoplastic PF group (29.3 % vs 23.9 %, p < 0.001) than non-neoplastic PF. No differences in soft tissue complications were found. When comparing neoplastic and non-neoplastic PF, the former had a higher rate of PE (2.5 % vs 1.0 %, p = 0.015) and post-operative bleeding (27.6 % vs 22.0 %, p = 0.009). Unplanned readmission rates and 30-day mortality rate were also higher in the neoplastic PF group.
CONCLUSIONS: Neoplastic PF of the hip are associated with higher risk of thromboembolic event rates and post-operative bleeding than both native hip fractures and non-neoplastic PF. No differences in rates of soft tissue complications were found between groups.
摘要：
背景：髋部骨折的手术治疗会导致严重的术后并发症。尽管病理性骨折（PF）与较差的结果相关，大多数研究没有区分病因(肿瘤和非肿瘤PF)。我们试图比较1）天然髋部骨折和肿瘤性PF之间的30天并发症发生率，和2)肿瘤和非肿瘤PF。
方法：从NSQIP数据库中检索到2005年至2021年诊断的127,819例髋部骨折患者和5104例PF患者。我们纳入了1843例肿瘤性PF患者和3261例非肿瘤性PF患者。人口统计,术前实验室和合并症，并对术后结果进行分析.进行倾向得分匹配以控制混杂因素。
结果：患有肿瘤性PF的患者深静脉血栓形成（DVT）的发生率明显更高（4％vs1.2％，p=0.001）和肺栓塞（PE）（2.4％vs0.7％，p<0.001)，比天然髋部骨折。肿瘤性PF组术后出血率明显较高（29.3％vs23.9％，p<0.001）比非肿瘤性PF。软组织并发症没有发现差异。当比较肿瘤性和非肿瘤性PF时，前者的PE率较高(2.5%vs1.0%，p=0.015）和术后出血（27.6%vs22.0%，p=0.009)。肿瘤性PF组的计划外再入院率和30天死亡率也较高。
结论：与天然髋部骨折和非肿瘤PF相比，髋部肿瘤PF与更高的血栓栓塞事件发生率和术后出血风险相关。两组间软组织并发症发生率无差异。
方法：从NSQIP数据库中检索到2005年至2021年诊断的127,819例髋部骨折患者和5104例PF患者。我们纳入了1843例肿瘤性PF患者和3261例非肿瘤性PF患者。人口统计,术前实验室和合并症，并对术后结果进行分析.进行倾向得分匹配以控制混杂因素。
结果：患有肿瘤性PF的患者深静脉血栓形成（DVT）的发生率明显更高（4％vs1.2％，p=0.001）和肺栓塞（PE）（2.4％vs0.7％，p<0.001)，比天然髋部骨折。肿瘤性PF组术后出血率明显较高（29.3％vs23.9％，p<0.001）比非肿瘤性PF。软组织并发症没有发现差异。当比较肿瘤性和非肿瘤性PF时，前者的PE率较高(2.5%vs1.0%，p=0.015）和术后出血（27.6%vs22.0%，p=0.009)。肿瘤性PF组的计划外再入院率和30天死亡率也较高。
结论：与天然髋部骨折和非肿瘤PF相比，髋部肿瘤PF与更高的血栓栓塞事件发生率和术后出血风险相关。两组间软组织并发症发生率无差异。
