目的:确定术后第一天活动程度与髋部骨折后30天死亡率之间的关系。
方法:队列研究。
方法:骨科医院急症病房。
方法:连续样本701名患者,65岁或以上,80%来自自己的家,49%的股骨转子骨折,61%的美国麻醉学学会等级>2。
方法:不适用。
方法:术后第一天的累积步行评分(CAS)(0-6分)和术后30天的死亡率。CAS=0反映无功能移动性(卧床不起),虽然CAS=6反映了独立的床外转移,椅子架,和室内步行状态。
结果:总体而言,86%的患者在术后第一天被动员到站立或坐在椅子上(CAS≥1)。观察到97(14%)的CAS为0、1-3和4-6,519(74%),85名(12%)患者,分别。总的来说,61例(8.7%)患者在30天内死亡,死亡率最高(23.7%,n=23)见于未动员的人(CAS=0)。只有一名CAS为4-6分的患者(1.2%)死亡。Cox回归分析调整了年龄,性别,居住状态,断裂前CAS,骨折类型,和美国麻醉学会等级,结果表明,一个单位的CAS增加与30天死亡率降低38%相关(危险比=0.63,95%置信区间,0.50-0.78)。
结论:术后第一天的移动性与术后30天的死亡率相关,对于那些完成更大流动性的人,观察到的风险较低。国家登记处可能会考虑在术后第一天将流动性收集从二元指标扩展到CAS,以捕获所达到的流动性程度。
OBJECTIVE: To determine the association between the extent of mobilisation within the first postoperative day and 30-day mortality after hip fracture.
METHODS: Cohort study.
METHODS: Acute orthopaedic hospital ward.
METHODS: Consecutive sample of 701 patients, 65 years of age or older, 80% from own home, 49% with a trochanteric fracture, and 61% with an American Society of Anesthesiology grade > 2.
METHODS: n/a.
METHODS: Cumulated ambulation score (CAS) (0-6 points) on the first postoperative day and 30-day postoperative mortality. A CAS = 0 reflects no functional mobility (bedridden), while a CAS = 6 reflects independent out-of-bed-transfer, chair-stand, and indoor walking status.
RESULTS: Overall, 86% of patients were mobilised to standing or seated in chair (CAS ≥ 1) on the first postoperative day. A CAS of 0, 1-3, and 4-6 was observed for 97 (14%), 519 (74%), and 85 (12%) patients, respectively. Overall, 61 (8.7%) patients died within 30 days with the highest mortality (23.7%, n = 23) seen for those not mobilised (CAS = 0). Only one patient (1.2%) with a CAS of 4-6 points died. Cox regression analysis adjusted for age, sex, residential status, pre-fracture CAS, fracture type, and American Society of Anesthesiology grade, showed that a one-unit increase in CAS was associated with a 38% lower risk of 30-day mortality (Hazard Ratio = 0.63, 95%Confidence Interval, 0.50-0.78).
CONCLUSIONS: Mobility on the first postoperative day was associated with 30-day postoperative mortality, with a lower risk observed for those completing greater mobility. National registries may consider extending collection of mobility on the first postoperative day from a binary indicator to the CAS which captures the extent of mobility achieved.