Burgos E, Gómez-Arnau J I, Díez R, Muñoz L, Fernández-Guisasola J, Garcia del Valle S
Anaesthesia Unit, Anaesthesia and Critical Care Department, Fundación Hospital Alcorcón, Madrid, Spain.
Acta Anaesthesiol Scand. 2008 Jan;52(1):125-31. doi: 10.1111/j.1399-6576.2007.01473.x. Epub 2007 Nov 8.
Hip fracture surgery is associated with high post-operative mortality and poor functional results: the excess mortality is 20% in the first year; of those patients who survive, only 50% recover their previous ability to walk. The purpose of this study was to assess the predictive value of six functional status and/or surgical risk scoring systems with regard to serious complications after hip fracture surgery in the elderly.
We performed a prospective study of a consecutive series of 232 patients (aged 65 years or older) undergoing hip fracture surgery. We pre-operatively applied: The American Society of Anesthesiologists classification, the Barthel index, the Goldman index, the Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM) scoring system, the Charlson index and the Visual Analogue Scale for Risk (RISK-VAS) scale. These scales were evaluated with respect to three variables: incidence of serious complications, the ability to walk after a 3-month period and 90-day survival. The predictive value of the different scales was assessed by the calculated area under a receiver operating characteristic curve.
The RISK-VAS scale, the POSSUM scoring system and the Charlson index reached a sufficient predictive value with regard to serious post-operative complications. The Barthel index and the RISK-VAS scale were those most useful for predicting ambulation at 3 months. None of the scales proved to be capable of predicting 90-day mortality.
A simple index such as the RISK-VAS scale was the best predictor of serious post-operative complications. The functional level before the fracture, measured with the Barthel index, had a major influence on the ambulation recovery.
髋部骨折手术与术后高死亡率及不良功能结果相关：第一年额外死亡率为20%；在存活的患者中，只有50%恢复到之前的行走能力。本研究的目的是评估六种功能状态和/或手术风险评分系统对老年髋部骨折手术后严重并发症的预测价值。
我们对连续232例（年龄65岁及以上）接受髋部骨折手术的患者进行了前瞻性研究。术前应用了：美国麻醉医师协会分级、Barthel指数、Goldman指数、生理和手术严重程度评分系统（用于死亡率和发病率的枚举，POSSUM）、Charlson指数和视觉模拟风险量表（RISK-VAS）。根据三个变量评估这些量表：严重并发症的发生率、3个月后的行走能力和90天生存率。通过计算受试者操作特征曲线下的面积评估不同量表的预测价值。
RISK-VAS量表、POSSUM评分系统和Charlson指数对术后严重并发症具有足够的预测价值。Barthel指数和RISK-VAS量表对预测3个月后的行走能力最有用。没有一个量表能够预测90天死亡率。
像RISK-VAS量表这样的简单指数是术后严重并发症的最佳预测指标。用Barthel指数测量的骨折前功能水平对行走恢复有重大影响。
