背景:老年骨折包括股骨远端和髋部骨折与高死亡率相关。目前,院内术后死亡率的预后因素尚未确定.我们旨在评估接受股骨远端骨折手术的老年患者的总体住院死亡率和相关潜在危险因素。
方法:一项60岁以上患者的回顾性队列研究,在2003年1月1日至2021年12月31日期间接受了股骨远端骨折手术的患者.进行了一项病例对照研究,以1:4的比例比较了两个年龄相等的老年患者的年龄匹配组。计算住院死亡率,并比较各组间潜在的混杂因素。
结果:共纳入170例患者,其中5例在手术后住院期间死亡,医院死亡率为2.94%。20例未死亡的患者被纳入对照组。患者的人口统计学特征相似。病例对照比较显示,从受伤到手术的时间,术前血红蛋白水平,估计肾小球滤过率(eGFR),白细胞计数是与住院死亡率相关的重要因素.
结论:总体住院死亡率为2.94%。住院死亡率的重要危险因素包括从受伤到手术的时间较长,降低术前血红蛋白水平和eGFR,术前白细胞计数较高。总之,术前综合老年评估,包括认知,营养,和脆弱的状态,老年骨折护理模式也应考虑。
BACKGROUND: Geriatric fractures including distal femur and hip fractures are associated with high mortality rates. Currently, prognostic factors for in-hospital postoperative mortality are not identified. We aimed to evaluate overall in-hospital mortality and related potential risk factors in elderly patients who underwent distal femur fracture surgery.
METHODS: A retrospective cohort study of patients older than 60 years, who underwent distal femur fracture surgery between January 01, 2003, and December 31, 2021, was conducted. A
case-control study was conducted to compare two age-matched groups of elderly patients of equivalent ages at a 1:4 ratio. The in-hospital mortality rate was calculated and potential confounders were compared between groups.
RESULTS: A total of 170 patients were enrolled; five died during hospital stay after undergoing surgery, yielding a 2.94% in-hospital mortality rate. Twenty patients who did not die were included in the control group. Patients\' demographics were similar. The
case-control comparison showed that the time from injury to surgery, preoperative hemoglobin level, estimated glomerular filtration rate (eGFR), and white blood cell count were significant factors correlated with in-hospital mortality.
CONCLUSIONS: The overall in-hospital mortality rate was 2.94%. Significant risk factors for in-hospital mortality included a longer time from injury to surgery, lower preoperative hemoglobin level and eGFR, and higher preoperative white blood cell count. In conclusion, preoperative comprehensive geriatric assessment, including cognitive, nutritional, and frailty status, should also be considered in the elderly fracture care model.