背景:股骨颈骨折患者的死亡率很高,尤其是在手术后的第一年,但此后也保持升高。这项研究的目的是确定在接受半髋关节置换术治疗的股骨颈骨折患者中可能与长期死亡率相关的因素。
方法:这项回顾性队列研究是在莱比锡大学医院的1级国家创伤中心进行的(萨克森州,德国)。研究时间窗口为2010年1月1日至2020年12月31日。主要结局指标是死亡率,取决于个体患者相关特征和围手术期危险因素。纳入标准是60岁或以上的老年患者的低能量股骨颈骨折(GardenI-IV),主要接受双极半髋关节置换术治疗。从德国东部萨克森州的人口登记册中获得了活着的患者的死亡日期或实际居住日期,德国。使用对数秩检验对结果进行测试,并使用Kaplan-Meier曲线绘制。未经调整和调整其他风险因素,如性别和年龄,使用Cox比例风险模型计算风险比,并用95%置信区间(CI)表示.
结果:纳入的458名患者的中位年龄为83(IQR77-89)岁,346例(75%)为女性,113例(25%)为男性。30天后的死亡率,1年、5年和10年为13%,25%,60%和80%,分别。多元回归分析显示年龄(HR=1.1;p<0.001),男性(HR=1.6;p<0.001),ASA评分3-4vs.1-2(HR=1.3;p<0.001),痴呆(HR=1.9;p<0.001)和恶性肿瘤病史(HR=1.6;p=0.002)是长期死亡风险较高的独立预测因素.围手术期因素如术前等待时间、早期手术并发症,或外科医生的经验与较高的总死亡率无关.
结论:在本研究中,根据萨克森州人口登记的数据,德国60岁以上老年股骨颈骨折患者的10年死亡率为80%。长期死亡率增加的独立危险因素是更高的患者年龄,男性,严重共病,癌症,特别是痴呆症的病史。围手术期因素不影响长期死亡率。
BACKGROUND: Mortality of patients with a femoral neck fracture is high, especially within the first year after surgery, but also remains elevated thereafter. The aim of this
study was to identify factors potentially associated with long-term mortality in patients homogeneously treated with hemiarthroplasty for femoral neck fracture.
METHODS: This retrospective cohort
study was performed at a single level 1 national trauma center at the university hospital of Leipzig (Saxony, Germany). The
study time-window was January 1, 2010 to December 31, 2020. Primary outcome measure was mortality depending on individual patient-related characteristics and perioperative risk factors. Inclusion criteria was a low-energy femoral neck fracture (Garden I-IV) in geriatric patients 60 years of age or older that were primarily treated with bipolar hemiarthroplasty. Date of death or actual residence of patients alive was obtained from the population register of the eastern German state of Saxony, Germany. The outcome was tested using the log-rank test and plotted using Kaplan-Meier curves. Unadjusted and adjusted for other risk factors such as sex and age, hazard ratios were calculated using Cox proportional hazards models and presented with 95% confidence intervals (CI).
RESULTS: The 458 included patients had a median age of 83 (IQR 77-89) years, 346 (75%) were female and 113 (25%) male patients. Mortality rates after 30 days, 1, 5 and 10 years were 13%, 25%, 60% and 80%, respectively. Multivariate regression analysis revealed age (HR = 1.1; p < 0.001), male gender (HR = 1.6; p < 0.001), ASA-Score 3-4 vs. 1-2 (HR = 1.3; p < 0.001), dementia (HR = 1.9; p < 0.001) and a history of malignancy (HR = 1.6; p = 0.002) as independent predictors for a higher long-term mortality risk. Perioperative factors such as preoperative waiting time, early surgical complications, or experience of the surgeon were not associated with a higher overall mortality.
CONCLUSIONS: In the present
study based on data from the population registry from Saxony, Germany the 10-year mortality of older patients above 60 years of age managed with hemiarthroplasty for femoral neck fracture was 80%. Independent risk factors for increased long-term mortality were higher patient age, male gender, severe comorbidity, a history of cancer and in particular dementia. Perioperative factors did not affect long-term mortality.