Abstract：
OBJECTIVE: To understand immediate and long-term outcomes following hip fracture surgery in adults with schizophrenia.
METHODS: Retrospective population-based cohort study leveraging health administrative databases from Ontario, Canada. Individuals aged 40-105 years with hip fracture surgery between April 1, 2009 and March 31, 2019 were included. Schizophrenia was ascertained using a validated algorithm. Outcomes were: 30-day mortality; 30-day readmission; 1-year survival; and subsequent hip fracture within 2 years. Analyses incorporated Generalized Estimating Equation models, Kaplan-Meier curves, and Fine-Gray competing risk models.
RESULTS: In this cohort study of 98,126 surgically managed hip fracture patients, the median [IQR] age was 83[75-89] years, 69.2% were women, and 3700(3.8%) had schizophrenia. In Fine-Gray models, schizophrenia was associated with subsequent hip fracture (sdRH, 1.29; 95% CI, 1.09-1.53), with male patients with schizophrenia sustaining a refracture 50 days earlier. In age- and sex-adjusted GEE models, schizophrenia was associated with 30-day mortality (OR, 1.31; 95% CI, 1.12-1.54) and readmissions (OR, 1.40; 95% CI, 1.25-1.56). Kaplan-Meier survival curves suggested that patients with schizophrenia were less likely to be alive at 1-year.
CONCLUSIONS: Study highlights the susceptibility of hip fracture patients with schizophrenia to worse outcomes, including refracture, with implications for understanding modifiable processes of care to optimize their recovery.
METHODS: Retrospective population-based cohort study leveraging health administrative databases from Ontario, Canada. Individuals aged 40-105 years with hip fracture surgery between April 1, 2009 and March 31, 2019 were included. Schizophrenia was ascertained using a validated algorithm. Outcomes were: 30-day mortality; 30-day readmission; 1-year survival; and subsequent hip fracture within 2 years. Analyses incorporated Generalized Estimating Equation models, Kaplan-Meier curves, and Fine-Gray competing risk models.
RESULTS: In this cohort study of 98,126 surgically managed hip fracture patients, the median [IQR] age was 83[75-89] years, 69.2% were women, and 3700(3.8%) had schizophrenia. In Fine-Gray models, schizophrenia was associated with subsequent hip fracture (sdRH, 1.29; 95% CI, 1.09-1.53), with male patients with schizophrenia sustaining a refracture 50 days earlier. In age- and sex-adjusted GEE models, schizophrenia was associated with 30-day mortality (OR, 1.31; 95% CI, 1.12-1.54) and readmissions (OR, 1.40; 95% CI, 1.25-1.56). Kaplan-Meier survival curves suggested that patients with schizophrenia were less likely to be alive at 1-year.
CONCLUSIONS: Study highlights the susceptibility of hip fracture patients with schizophrenia to worse outcomes, including refracture, with implications for understanding modifiable processes of care to optimize their recovery.
摘要：
目的：了解成人精神分裂症患者髋部骨折手术后的近期和长期结局。
方法：利用安大略省卫生管理数据库的基于人群的回顾性队列研究，加拿大。纳入2009年4月1日至2019年3月31日期间进行髋部骨折手术的40-105岁个体。使用经过验证的算法确定精神分裂症。结果为：30天死亡率；30天再入院；1年生存率；以及2年内的髋部骨折。结合广义估计方程模型进行分析，卡普兰-迈耶曲线,和精细灰色竞争风险模型。
结果：在这项98,126例手术治疗髋部骨折患者的队列研究中，[IQR]年龄中位数为83[75-89]岁，69.2%是女性，3700人(3.8%)患有精神分裂症。在Fine-Gray模型中,精神分裂症与随后的髋部骨折(sdRH，1.29；95%CI，1.09-1.53），男性精神分裂症患者在50天前再次骨折。在年龄和性别调整的GEE模型中，精神分裂症与30天死亡率相关(OR，1.31；95%CI，1.12-1.54)和再入院(OR，1.40；95%CI，1.25-1.56）。Kaplan-Meier生存曲线表明精神分裂症患者在1年时存活的可能性较小。
结论：研究强调了髋部骨折合并精神分裂症患者对不良预后的易感性，包括再骨折,对理解可修改的护理过程以优化其恢复具有重要意义。
方法：利用安大略省卫生管理数据库的基于人群的回顾性队列研究，加拿大。纳入2009年4月1日至2019年3月31日期间进行髋部骨折手术的40-105岁个体。使用经过验证的算法确定精神分裂症。结果为：30天死亡率；30天再入院；1年生存率；以及2年内的髋部骨折。结合广义估计方程模型进行分析，卡普兰-迈耶曲线,和精细灰色竞争风险模型。
结果：在这项98,126例手术治疗髋部骨折患者的队列研究中，[IQR]年龄中位数为83[75-89]岁，69.2%是女性，3700人(3.8%)患有精神分裂症。在Fine-Gray模型中,精神分裂症与随后的髋部骨折(sdRH，1.29；95%CI，1.09-1.53），男性精神分裂症患者在50天前再次骨折。在年龄和性别调整的GEE模型中，精神分裂症与30天死亡率相关(OR，1.31；95%CI，1.12-1.54)和再入院(OR，1.40；95%CI，1.25-1.56）。Kaplan-Meier生存曲线表明精神分裂症患者在1年时存活的可能性较小。
结论：研究强调了髋部骨折合并精神分裂症患者对不良预后的易感性，包括再骨折,对理解可修改的护理过程以优化其恢复具有重要意义。
