Koval Kenneth J, Zhou Weiping, Sparks Michael J, Cantu Robert V, Hecht Paul, Lurie Jon
Dartmouth Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, USA.
Foot Ankle Int. 2007 Dec;28(12):1249-55. doi: 10.3113/FAI.2007.1249.
Controversy exists regarding the risks and benefits of ankle fracture treatment in elderly patients. The purpose of this study was to use the United States Medicare database to determine the complication rate for ankle fractures in elderly patients treated operatively and to compare it to fractures treated nonoperatively.
We used the National Medicare Claims History System to study all enrollees who sustained ankle fractures between 1998 and 2001. A total of 33,704 patients were identified and their outcomes at numerous time points were evaluated. These outcomes included mortality, rate of repeat hospitalization, rate of medical and operative complications, and the rate of additional surgery. The predictor variables were either nonoperative or operative intervention. Covariates included patient age, gender, race, medical comorbidity status, and fracture type.
Patients treated nonoperatively had significantly higher mortality (p < 0.05) than those treated operatively at all time periods except for 30 days. However, patients treated operatively had significantly higher rehospitalization rates (p < 0.05) at all time periods studied. The medical and operative complication rates at all time periods were less than or equal to 2% for patients who had either operative or nonoperative treatment. In the group that had operative management, a relatively small number of patients had additional procedures. Eleven percent had removal of hardware. Less than 1% of all patients had revision of the internal fixation, arthroplasty, arthrodesis, or amputation.
In properly selected cases, the complication rates of both operatively and nonoperatively treated elderly patients are low.
老年患者踝关节骨折治疗的风险与益处存在争议。本研究旨在利用美国医疗保险数据库确定老年患者手术治疗踝关节骨折的并发症发生率，并与非手术治疗的骨折进行比较。
我们使用国家医疗保险理赔历史系统研究了1998年至2001年间所有发生踝关节骨折的参保者。共识别出33704例患者，并评估了他们在多个时间点的结局。这些结局包括死亡率、再次住院率、医疗和手术并发症发生率以及额外手术率。预测变量为非手术或手术干预。协变量包括患者年龄、性别、种族、医疗合并症状态和骨折类型。
除30天外，在所有时间段内，非手术治疗的患者死亡率均显著高于手术治疗的患者（p < 0.05）。然而，在所有研究时间段内，手术治疗的患者再次住院率显著更高（p < 0.05）。接受手术或非手术治疗的患者在所有时间段的医疗和手术并发症发生率均小于或等于2%。在接受手术治疗的组中，进行额外手术的患者相对较少。11%的患者取出了内固定物。所有患者中不到1%进行了内固定翻修、关节成形术、关节融合术或截肢术。
在恰当选择的病例中，老年患者手术和非手术治疗的并发症发生率均较低。
