PDF(Pubmed)
Abstract：
Globally, hip fractures in elderly individuals are a prevalent and serious issue. Patients typically have a longer length of stay (LOS), which increases the risk of complications and increases hospitalization costs. Hemoglobin (Hb) is a routine blood test that is associated with disease prognosis. This study aimed to investigate the relationship between preoperative Hb and LOS in elderly hip fracture patients and to determine a reliable transfusion threshold. The clinical data of hip fracture patients (aged ≥ 60 years) admitted to the Department of Orthopaedics, Shenzhen Second People\'s Hospital, between January 2012 and December 2021 were retrospectively analyzed. Multiple linear regression analysis was used to assess the linear relationship between preoperative Hb and LOS. Smooth curve fitting was performed to investigate potential nonlinear relationships. In the case of discovering nonlinear relationships, a weighted two-piecewise linear regression model was built, and the inflection points were determined using a recursive algorithm. Subgroup analyses were conducted based on age and gender. A total of 1444 patients with an average age of (77.54 ± 8.73) years were enrolled. After adjusting for covariates, a nonlinear relationship was found between preoperative Hb and LOS. The two-piecewise linear regression model revealed an inflection point of 10 g/dL. On the left of the inflection point (Hb < 10 g/dL), the LOS was reduced by 0.735 days for every 1 g/dL increase in Hb (β = -0.735, 95% confidence interval: -1.346 to -0.124, P = .019). On the right side of the inflection point (Hb > 10 g/dL), the relationship was not statistically significant (β = 0.001, 95% confidence interval: -0.293 to 0.296, P = .992). In elderly hip fracture patients, there is a nonlinear association between preoperative Hb and LOS. However, when Hb levels were <10 g/dL, there was a negative correlation with the LOS. No correlation was observed when Hb levels were >10 g/dL. These findings underscore the importance of timely intervention to manage Hb levels in elderly patients with hip fractures, potentially reducing hospitalization durations and associated complications.
摘要：
全球范围内,老年人髋部骨折是一个普遍而严重的问题。患者通常有更长的住院时间（LOS），这增加了并发症的风险并增加了住院费用。血红蛋白（Hb）是与疾病预后相关的常规血液检查。本研究旨在探讨老年髋部骨折患者术前Hb与LOS的关系，并确定可靠的输血阈值。骨科收治的髋部骨折患者(年龄≥60岁)的临床资料,深圳市第二人民医院,对2012年1月至2021年12月间的数据进行回顾性分析.采用多元线性回归分析评估术前Hb与LOS的线性关系。进行平滑曲线拟合以研究潜在的非线性关系。在发现非线性关系的情况下，建立加权二分段线性回归模型,并使用递归算法确定拐点。根据年龄和性别进行亚组分析。共纳入1444例患者，平均年龄（77.54±8.73）岁。在调整协变量后，术前Hb和LOS之间存在非线性关系。两分段线性回归模型显示10g/dL的拐点。在拐点的左侧（Hb<10g/dL），Hb每增加1g/dL，LOS降低0.735天（β=-0.735，95％置信区间：-1.346至-0.124，P=0.019）。在拐点的右侧（Hb>10g/dL），上述关系无统计学意义(β=0.001,95%置信区间:-0.293~0.296,P=.992).在老年髋部骨折患者中，术前Hb和LOS之间存在非线性关联。然而,当Hb水平<10g/dL时，与LOS呈负相关。当Hb水平>10g/dL时,没有观察到相关性。这些发现强调了及时干预以管理老年髋部骨折患者Hb水平的重要性。可能减少住院时间和相关并发症。
