PDF(Pubmed)
Abstract：
OBJECTIVE: Distal femur fractures remain a significant cause of morbidity and mortality for elderly patients. There is a lack of large population studies investigating short-term outcomes after distal femur c in elderly patients. The purpose of this study is to assess the incidence of and risk factors for various short-term outcomes after distal femur open reduction internal fixation (ORIF) in the geriatric population.
METHODS: The American College of Surgeons\' National Surgical Quality Improvement Program (NSQIP) database was used to identify all primary distal femur ORIF cases in patients 60+ years old between January 1, 2015 and December 31, 2020 using Current Procedural Terminology (CPT) codes 27511, 27513, and 27514. Demographic, medical, and surgical variables were extracted for all patients. Propensity score matching was used to match cases in the two age groups based on various demographic and medical comorbidity variables. Several 30-day outcome measures were compared between the 60-79-year-old and 80+-year-old groups both before and after matching. Subsequent multivariate logistic regression was used to identify independent risk factors for 30-day outcome measures in the matched cohort.
RESULTS: A total of 2913 patients were included in the final cohort: 1711 patients in the 60-79-year-old group and 1202 patients in the 80+-year-old group. Most patients were female (n = 2385; 81.9%). Prior to matching, the older group had a higher incidence of 30-day mortality (1.9% vs. 6.2%), readmission (3.7% vs. 9.7%, p = 0.024), and non-home discharge (74.3% vs. 89.5%, p < 0.001). Additionally, the older group had a higher rate of blood loss requiring transfusion (30.9% vs. 42.3%, p < 0.001) and medical complications (10.4% vs. 16.4%, p < 0.001), including myocardial infarction (0.7% vs. 2.7%, p < 0.001), pneumonia (2.7% vs. 4.6%, p = 0.008), and urinary tract infection (4.1% vs. 6.1%, p = 0.0188). After matching, the older group consistently had a higher incidence of mortality, non-home-discharge, blood loss requiring transfusion, and myocardial infarction. Various independent risk factors were identified for 30-day morbidity and mortality, including American Society of Anesthesiologists (ASA) classification, body mass index (BMI) status, operative duration, and certain medical comorbidities.
CONCLUSIONS: Geriatric patients undergoing distal femur ORIF are at significant risk for 30-day morbidity and mortality. After matching, octogenarians and older patients specifically are at increased risk for mortality, non-home discharge, and surgical complications compared to patients aged 60-79 years old. Multiple factors, such as BMI status, ASA classification, operative time, and certain medical comorbidities, are independently associated with poor 30-day outcomes.
METHODS: The American College of Surgeons\' National Surgical Quality Improvement Program (NSQIP) database was used to identify all primary distal femur ORIF cases in patients 60+ years old between January 1, 2015 and December 31, 2020 using Current Procedural Terminology (CPT) codes 27511, 27513, and 27514. Demographic, medical, and surgical variables were extracted for all patients. Propensity score matching was used to match cases in the two age groups based on various demographic and medical comorbidity variables. Several 30-day outcome measures were compared between the 60-79-year-old and 80+-year-old groups both before and after matching. Subsequent multivariate logistic regression was used to identify independent risk factors for 30-day outcome measures in the matched cohort.
RESULTS: A total of 2913 patients were included in the final cohort: 1711 patients in the 60-79-year-old group and 1202 patients in the 80+-year-old group. Most patients were female (n = 2385; 81.9%). Prior to matching, the older group had a higher incidence of 30-day mortality (1.9% vs. 6.2%), readmission (3.7% vs. 9.7%, p = 0.024), and non-home discharge (74.3% vs. 89.5%, p < 0.001). Additionally, the older group had a higher rate of blood loss requiring transfusion (30.9% vs. 42.3%, p < 0.001) and medical complications (10.4% vs. 16.4%, p < 0.001), including myocardial infarction (0.7% vs. 2.7%, p < 0.001), pneumonia (2.7% vs. 4.6%, p = 0.008), and urinary tract infection (4.1% vs. 6.1%, p = 0.0188). After matching, the older group consistently had a higher incidence of mortality, non-home-discharge, blood loss requiring transfusion, and myocardial infarction. Various independent risk factors were identified for 30-day morbidity and mortality, including American Society of Anesthesiologists (ASA) classification, body mass index (BMI) status, operative duration, and certain medical comorbidities.
CONCLUSIONS: Geriatric patients undergoing distal femur ORIF are at significant risk for 30-day morbidity and mortality. After matching, octogenarians and older patients specifically are at increased risk for mortality, non-home discharge, and surgical complications compared to patients aged 60-79 years old. Multiple factors, such as BMI status, ASA classification, operative time, and certain medical comorbidities, are independently associated with poor 30-day outcomes.
摘要：
目的：股骨远端骨折仍然是老年患者发病率和死亡率的重要原因。缺乏调查老年患者股骨远端c术后短期预后的大型人群研究。这项研究的目的是评估老年人群股骨远端切开复位内固定术（ORIF）后各种短期结局的发生率和危险因素。
方法：美国外科医生学会国家外科质量改进计划（NSQIP）数据库用于识别2015年1月1日至2020年12月31日之间60岁以上患者的所有原发性股骨远端ORIF病例，使用当前程序术语（CPT）代码27511、27513和27514。人口统计,medical,并提取所有患者的手术变量。根据各种人口统计学和医学合并症变量，使用倾向评分匹配来匹配两个年龄组的病例。在匹配之前和之后，比较了60-79岁和80岁以上组之间的几个30天结果指标。随后的多变量逻辑回归用于确定匹配队列中30天结局指标的独立危险因素。
结果：最终队列共纳入2913例患者：60-79岁组1711例患者，80+岁组1202例患者。大多数患者为女性（n=2385；81.9%）。在匹配之前，老年组30天死亡率较高(1.9%vs.6.2%)，再入院（3.7%与9.7%,p=0.024),和非家庭放电(74.3%vs.89.5%,p<0.001)。此外,老年组需要输血的失血率较高(30.9%vs.42.3%,p<0.001）和医疗并发症（10.4%vs.16.4%,p<0.001)，包括心肌梗死（0.7%vs.2.7%,p<0.001)，肺炎（2.7%vs.4.6%,p=0.008),和尿路感染(4.1%vs.6.1%,p=0.0188)。匹配后,老年组的死亡率一直较高，非家庭放电，失血需要输血,和心肌梗塞。确定了30天发病率和死亡率的各种独立危险因素，包括美国麻醉医师协会（ASA）分类，身体质量指数（BMI）状态，手术持续时间,和某些医疗合并症。
结论：老年患者接受股骨远端ORIF的30天发病和死亡风险显著。匹配后,特别是八十岁和老年患者的死亡风险增加，非家庭放电，与60-79岁患者相比，手术并发症。多重因素,例如BMI状态，ASA分类，手术时间,和某些医疗合并症，与差的30天结果独立相关。
方法：美国外科医生学会国家外科质量改进计划（NSQIP）数据库用于识别2015年1月1日至2020年12月31日之间60岁以上患者的所有原发性股骨远端ORIF病例，使用当前程序术语（CPT）代码27511、27513和27514。人口统计,medical,并提取所有患者的手术变量。根据各种人口统计学和医学合并症变量，使用倾向评分匹配来匹配两个年龄组的病例。在匹配之前和之后，比较了60-79岁和80岁以上组之间的几个30天结果指标。随后的多变量逻辑回归用于确定匹配队列中30天结局指标的独立危险因素。
结果：最终队列共纳入2913例患者：60-79岁组1711例患者，80+岁组1202例患者。大多数患者为女性（n=2385；81.9%）。在匹配之前，老年组30天死亡率较高(1.9%vs.6.2%)，再入院（3.7%与9.7%,p=0.024),和非家庭放电(74.3%vs.89.5%,p<0.001)。此外,老年组需要输血的失血率较高(30.9%vs.42.3%,p<0.001）和医疗并发症（10.4%vs.16.4%,p<0.001)，包括心肌梗死（0.7%vs.2.7%,p<0.001)，肺炎（2.7%vs.4.6%,p=0.008),和尿路感染(4.1%vs.6.1%,p=0.0188)。匹配后,老年组的死亡率一直较高，非家庭放电，失血需要输血,和心肌梗塞。确定了30天发病率和死亡率的各种独立危险因素，包括美国麻醉医师协会（ASA）分类，身体质量指数（BMI）状态，手术持续时间,和某些医疗合并症。
结论：老年患者接受股骨远端ORIF的30天发病和死亡风险显著。匹配后,特别是八十岁和老年患者的死亡风险增加，非家庭放电，与60-79岁患者相比，手术并发症。多重因素,例如BMI状态，ASA分类，手术时间,和某些医疗合并症，与差的30天结果独立相关。
