PDF(Pubmed)
Abstract：
BACKGROUND: The accelerated growth of older individuals worldwide has increased the number of patients presenting with fragility hip fractures. Having a hip fracture can cause excess mortality, and patients with hip fracture have a higher risk of death than those without hip fracture. Most studies have treated hip fracture as a single, homogeneous condition, but hip fracture includes two major anatomic types: intertrochanteric fracture and femoral neck fracture. Few studies have specifically evaluated 1-year mortality risk in older individuals with femoral intertrochanteric fracture. The aim of this study was to evaluate 1-year mortality and factors associated with mortality in older individuals with femoral intertrochanteric fracture.
METHODS: A retrospective review was conducted of 563 patients ≥ 65 years old who underwent surgery for femoral intertrochanteric fractures at our institution between January 2010 and August 2018. Patient demographics, comorbidities, and treatment were collected by retrospective chart review. Age, sex, Body Mass Index (BMI), American Society of Anesthesiologists (ASA) classification, Charlson comorbidity index (CCI), Arbeitsgemeinschaft Für Osteosynthesefragen (AO) fracture classification, haemoglobin value at admission, time to surgery, operation time, and intraoperative blood loss were risk factors to be tested. Multivariable logistic regression was used to evaluate associations between variables and death.
RESULTS: Among the 563 patients, 49 died within 1 year after surgery, and the 1-year mortality rate was 8.7%. Multivariate analysis identified age > 80 years (OR = 4.038, P = 0.011), haemoglobin < 100 g/l (OR = 2.732, P = 0.002), ASA score ≥ 3 (OR = 2.551, P = 0.005), CCI ≥ 3 (OR = 18.412, P = 0.018) and time to surgery > 14 d (OR = 3.907, P = 0.030) as independent risk factors for 1-year mortality. Comorbidities such as myocardial infarction and chronic pulmonary disease were associated with 1-year mortality after adjusting for age > 80 years and time to surgery > 14 days.
CONCLUSIONS: Patients over 80 years old with haemoglobin < 100 g/l, ASA score ≥ 3, CCI ≥ 3, and multiple comorbidities, especially myocardial infarction and chronic pulmonary disease before surgery, are at a higher risk of 1-year mortality. Doctors should pay more attention to these vulnerable patients, and a surgical delay greater than 14 days should be avoided.
METHODS: A retrospective review was conducted of 563 patients ≥ 65 years old who underwent surgery for femoral intertrochanteric fractures at our institution between January 2010 and August 2018. Patient demographics, comorbidities, and treatment were collected by retrospective chart review. Age, sex, Body Mass Index (BMI), American Society of Anesthesiologists (ASA) classification, Charlson comorbidity index (CCI), Arbeitsgemeinschaft Für Osteosynthesefragen (AO) fracture classification, haemoglobin value at admission, time to surgery, operation time, and intraoperative blood loss were risk factors to be tested. Multivariable logistic regression was used to evaluate associations between variables and death.
RESULTS: Among the 563 patients, 49 died within 1 year after surgery, and the 1-year mortality rate was 8.7%. Multivariate analysis identified age > 80 years (OR = 4.038, P = 0.011), haemoglobin < 100 g/l (OR = 2.732, P = 0.002), ASA score ≥ 3 (OR = 2.551, P = 0.005), CCI ≥ 3 (OR = 18.412, P = 0.018) and time to surgery > 14 d (OR = 3.907, P = 0.030) as independent risk factors for 1-year mortality. Comorbidities such as myocardial infarction and chronic pulmonary disease were associated with 1-year mortality after adjusting for age > 80 years and time to surgery > 14 days.
CONCLUSIONS: Patients over 80 years old with haemoglobin < 100 g/l, ASA score ≥ 3, CCI ≥ 3, and multiple comorbidities, especially myocardial infarction and chronic pulmonary disease before surgery, are at a higher risk of 1-year mortality. Doctors should pay more attention to these vulnerable patients, and a surgical delay greater than 14 days should be avoided.
摘要：
背景：全球老年人群的加速生长增加了脆性髋部骨折患者的数量。髋部骨折会导致额外的死亡率，与没有髋部骨折的患者相比，髋部骨折的患者死亡风险更高。大多数研究都将髋部骨折作为一个单一的，均匀条件，但髋部骨折包括两种主要的解剖类型:股骨粗隆间骨折和股骨颈骨折。很少有研究专门评估老年股骨粗隆间骨折患者1年死亡风险。这项研究的目的是评估老年股骨粗隆间骨折患者的1年死亡率和与死亡率相关的因素。
方法：对2010年1月至2018年8月在我院接受股骨粗隆间骨折手术的563例≥65岁患者进行了回顾性研究。患者人口统计学，合并症,和治疗通过回顾性图表回顾收集。年龄,性别,身体质量指数(BMI),美国麻醉医师协会（ASA）分类，Charlson合并症指数（CCI），阿贝氏骨折（AO）分类，入院时的血红蛋白值，手术时间到了,操作时间,术中失血是需要检测的危险因素。多变量逻辑回归用于评估变量与死亡之间的关联。
结果：在563名患者中，手术后1年内死亡49人,1年死亡率为8.7%。多因素分析确定年龄>80岁(OR=4.038,P=0.011),血红蛋白<100g/l（OR=2.732，P=0.002），ASA评分≥3分(OR=2.551,P=0.005),CCI≥3(OR=18.412,P=0.018)和手术时间>14d(OR=3.907,P=0.030)是1年死亡率的独立危险因素。在调整年龄>80岁和手术时间>14天后，诸如心肌梗死和慢性肺病的合并症与1年死亡率相关。
结论：80岁以上血红蛋白<100g/l的患者，ASA评分≥3，CCI≥3和多种合并症，特别是心肌梗塞和慢性肺病手术前，1年死亡率的风险较高。医生应该多关注这些脆弱的患者，应避免手术延迟超过14天。
方法：对2010年1月至2018年8月在我院接受股骨粗隆间骨折手术的563例≥65岁患者进行了回顾性研究。患者人口统计学，合并症,和治疗通过回顾性图表回顾收集。年龄,性别,身体质量指数(BMI),美国麻醉医师协会（ASA）分类，Charlson合并症指数（CCI），阿贝氏骨折（AO）分类，入院时的血红蛋白值，手术时间到了,操作时间,术中失血是需要检测的危险因素。多变量逻辑回归用于评估变量与死亡之间的关联。
结果：在563名患者中，手术后1年内死亡49人,1年死亡率为8.7%。多因素分析确定年龄>80岁(OR=4.038,P=0.011),血红蛋白<100g/l（OR=2.732，P=0.002），ASA评分≥3分(OR=2.551,P=0.005),CCI≥3(OR=18.412,P=0.018)和手术时间>14d(OR=3.907,P=0.030)是1年死亡率的独立危险因素。在调整年龄>80岁和手术时间>14天后，诸如心肌梗死和慢性肺病的合并症与1年死亡率相关。
结论：80岁以上血红蛋白<100g/l的患者，ASA评分≥3，CCI≥3和多种合并症，特别是心肌梗塞和慢性肺病手术前，1年死亡率的风险较高。医生应该多关注这些脆弱的患者，应避免手术延迟超过14天。
