Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, 2 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104, USA.
J Bone Joint Surg Am. 2010 Apr;92(4):807-13. doi: 10.2106/JBJS.I.00571.
Comorbidities before and complications following hip fracture surgery can impact the return of function. We hypothesized that the American Society of Anesthesiologists (ASA) classification of medical comorbidities is a useful surrogate variable for the patient's general medical condition and would be a strong predictor of perioperative medical complications following hip fracture surgery.
A retrospective review of the cases of 197 elderly patients who had undergone operative management of a hip fracture was performed. The ASA class, data regarding perioperative medical and surgical complications, and demographic data were obtained. Medical complications were defined as those requiring intervention by an internist or medical specialist. Differences in complication rates among the ASA classes were determined.
Medical complications were more common in patients in ASA class 3 (p < 0.001) and those in class 4 (p = 0.001) than in those in class 2. Patients in ASA class 3 had a 3.78 times greater chance of having a medical complication than did those in class 2 (p < 0.001). Patients in ASA class 4 had a 7.39 times greater chance of having medical complications than did those in class 2 (p = 0.001). No significant relationship was identified between the ASA class and surgical complications.
The ASA class is strongly associated with medical problems in the perioperative period following hip fracture surgery in the elderly. Patients identified as being at higher risk (in ASA class 3 or 4) preoperatively should be closely managed medically so that perioperative medical complications can be managed and evolving medical issues can be addressed in a timely fashion.
髋部骨折手术前后的合并症会影响功能的恢复。我们假设美国麻醉医师协会（ASA）的医学合并症分类是患者一般健康状况的有用替代变量，并且是髋部骨折手术后围手术期医疗并发症的有力预测指标。
回顾性分析了 197 例接受髋关节骨折手术治疗的老年患者的病例。获得了 ASA 分级、围手术期内科和外科并发症的数据以及人口统计学数据。内科并发症定义为需要内科医生或医学专家干预的并发症。确定了 ASA 分级之间并发症发生率的差异。
ASA 分级 3 级（p < 0.001）和 4 级（p = 0.001）患者的内科并发症发生率高于 2 级患者。ASA 分级 3 级患者发生内科并发症的几率是 2 级患者的 3.78 倍（p < 0.001）。ASA 分级 4 级患者发生内科并发症的几率是 2 级患者的 7.39 倍（p = 0.001）。ASA 分级与手术并发症之间无显著关系。
ASA 分级与老年髋部骨折手术后围手术期内科问题密切相关。术前被认为风险较高的患者（ASA 分级 3 级或 4 级）应进行密切的内科管理，以便能够处理围手术期内科并发症，并及时解决不断出现的内科问题。
