Abstract：
BACKGROUND: Pulmonary hypertension (PHTN) is associated with increased morbidity and mortality in noncardiac surgery and elective surgery. This population of patients has a low physiological reserve and is prone to cardiac arrest as a result. This study aims to identify the impact that PHTN has on outcomes among geriatric hip fracture patients.
METHODS: A 3:1 propensity-score-matched retrospective case (PHTN)-control (no PHTN [N]) study of hip fracture patients from 2014 to 2022 was performed. Patients were matched utilizing propensity score matching of a validated geriatric trauma risk assessment tool (STTGMA). All patients were reviewed for hospital quality measures and outcomes. Comparative univariable and multivariable analyses were conducted between the two matched cohorts. A sub-analysis compared patients across PHTN severity levels (mild, moderate, severe) based on pulmonary artery systolic pressures (PASP) as measured by transthoracic echocardiogram.
RESULTS: PHTN patients (n = 67) experienced a higher rate of inpatient, 30-day, and 1-year mortality, major complications, and 90-day readmissions as compared to the N cohort (n = 201). PHTN patients with a PASP > 60 experienced a significantly higher rate of major complications, need for ICU, longer admission length, and worse 1-year functional outcomes. Pulmonary hypertension was found to be independently associated with a 3.5 × higher rate of 30-day mortality (p = 0.016), 2.7 × higher rate of 1-year mortality (p = 0.008), 2.5 × higher rate of a major inpatient complication (p = 0.028), and 1.2 × higher rate of 90-day readmission (p = 0.044).
CONCLUSIONS: Patients who had a prior diagnosis of pulmonary hypertension before sustaining their hip fracture experienced significantly worse inpatient and post-discharge outcomes. Those with a PASP > 60 mmHg had worse outcomes within the PHTN cohort. Providers must recognize these at-risk patients at the time of arrival to adjust care planning accordingly.
METHODS: III.
METHODS: A 3:1 propensity-score-matched retrospective case (PHTN)-control (no PHTN [N]) study of hip fracture patients from 2014 to 2022 was performed. Patients were matched utilizing propensity score matching of a validated geriatric trauma risk assessment tool (STTGMA). All patients were reviewed for hospital quality measures and outcomes. Comparative univariable and multivariable analyses were conducted between the two matched cohorts. A sub-analysis compared patients across PHTN severity levels (mild, moderate, severe) based on pulmonary artery systolic pressures (PASP) as measured by transthoracic echocardiogram.
RESULTS: PHTN patients (n = 67) experienced a higher rate of inpatient, 30-day, and 1-year mortality, major complications, and 90-day readmissions as compared to the N cohort (n = 201). PHTN patients with a PASP > 60 experienced a significantly higher rate of major complications, need for ICU, longer admission length, and worse 1-year functional outcomes. Pulmonary hypertension was found to be independently associated with a 3.5 × higher rate of 30-day mortality (p = 0.016), 2.7 × higher rate of 1-year mortality (p = 0.008), 2.5 × higher rate of a major inpatient complication (p = 0.028), and 1.2 × higher rate of 90-day readmission (p = 0.044).
CONCLUSIONS: Patients who had a prior diagnosis of pulmonary hypertension before sustaining their hip fracture experienced significantly worse inpatient and post-discharge outcomes. Those with a PASP > 60 mmHg had worse outcomes within the PHTN cohort. Providers must recognize these at-risk patients at the time of arrival to adjust care planning accordingly.
METHODS: III.
摘要：
背景：肺动脉高压（PHTN）与非心脏手术和择期手术的发病率和死亡率增加相关。该患者群体具有低的生理储备并且因此容易发生心脏骤停。本研究旨在确定PHTN对老年髋部骨折患者预后的影响。
方法：对2014年至2022年髋部骨折患者进行3:1倾向评分匹配的回顾性病例（PHTN）对照（无PHTN[N]）研究。使用经过验证的老年创伤风险评估工具（STTGMA）的倾向评分匹配对患者进行匹配。对所有患者进行医院质量测量和结果回顾。在两个匹配的队列之间进行比较单变量和多变量分析。一项子分析比较了不同PHTN严重程度的患者(轻度，中度,严重）基于经胸超声心动图测得的肺动脉收缩压（PASP）。
结果：PHTN患者（n=67）住院率较高，30天,和1年死亡率，主要并发症,与N队列相比，再入院90天（n=201）。PASP>60的PHTN患者的主要并发症发生率明显较高，需要ICU，较长的入场长度，更差的1年功能结果。发现肺动脉高压与30天死亡率的3.5倍独立相关（p=0.016）。2.7×1年死亡率高（p=0.008），主要住院并发症的发生率高2.5倍（p=0.028），90天再入院率高于1.2倍（p=0.044）。
结论：在髋部骨折之前曾被诊断为肺动脉高压的患者在住院和出院后的预后明显更差。PASP>60mmHg的患者在PHTN队列中的预后较差。提供者必须在到达时识别这些有风险的患者，以相应地调整护理计划。
方法：III.
方法：对2014年至2022年髋部骨折患者进行3:1倾向评分匹配的回顾性病例（PHTN）对照（无PHTN[N]）研究。使用经过验证的老年创伤风险评估工具（STTGMA）的倾向评分匹配对患者进行匹配。对所有患者进行医院质量测量和结果回顾。在两个匹配的队列之间进行比较单变量和多变量分析。一项子分析比较了不同PHTN严重程度的患者(轻度，中度,严重）基于经胸超声心动图测得的肺动脉收缩压（PASP）。
结果：PHTN患者（n=67）住院率较高，30天,和1年死亡率，主要并发症,与N队列相比，再入院90天（n=201）。PASP>60的PHTN患者的主要并发症发生率明显较高，需要ICU，较长的入场长度，更差的1年功能结果。发现肺动脉高压与30天死亡率的3.5倍独立相关（p=0.016）。2.7×1年死亡率高（p=0.008），主要住院并发症的发生率高2.5倍（p=0.028），90天再入院率高于1.2倍（p=0.044）。
结论：在髋部骨折之前曾被诊断为肺动脉高压的患者在住院和出院后的预后明显更差。PASP>60mmHg的患者在PHTN队列中的预后较差。提供者必须在到达时识别这些有风险的患者，以相应地调整护理计划。
方法：III.
