Menzies Isaura B, Mendelson Daniel A, Kates Stephen L, Friedman Susan M
Department of Medicine, University of Vermont College of Medicine, Burlington, VT, USA.
Geriatr Orthop Surg Rehabil. 2012 Sep;3(3):129-34. doi: 10.1177/2151458512463392.
Older adults who sustain hip fractures usually have multiple coexisting medical problems that may impact their treatment and outcomes. The geriatric fracture center (GFC) provides a model of care that standardizes treatment and optimizes outcomes. The purpose of this study is to determine whether GFC patients with a higher burden of comorbidity or specific comorbidities are at risk for worsened perioperative outcomes, such as increased time to surgery (TTS), postoperative complications, and longer length of hospital stay (LOS).
A total of 1077 patients aged 60 years and older who underwent surgery for a proximal femur fracture between April 15, 2005, and September 30, 2010, were evaluated. Comorbidities measured in the Charlson Comorbidity index were abstracted through chart review. Outcomes were TTS, postoperative complications, and LOS.
Most patients were white, with an average age of 85. One half lived in either a nursing home or an assisted living facility. The mean Charlson score was 3.06 and the nursing home residents had a significantly higher score compared to community dwellers (3.4 vs 2.8; P < .0001). Dementia was the most common comorbidity. There was no difference in the LOS or TTS based on Charlson score. The overall complication rate was 44% with delirium being the most common postoperative complication. Peripheral vascular disease, history of solid tumor, and peptic ulcer disease predicted delirium incidence. Charlson score predicted complication risk, with an odds ratio of 1.12 for each point increase.
Frailty and comorbidity put this hip fracture population at high risk for adverse perioperative outcomes. This study shows that in the GFC model of care the comorbidity burden did not impact the TTS and LOS but did predict postoperative complication rate.
髋部骨折的老年人通常存在多种并存的医疗问题，这些问题可能会影响他们的治疗和预后。老年骨折中心（GFC）提供了一种标准化治疗并优化预后的护理模式。本研究的目的是确定合并症负担较高或患有特定合并症的GFC患者是否存在围手术期预后恶化的风险，如手术时间（TTS）延长、术后并发症和住院时间（LOS）延长。
对2005年4月15日至2010年9月30日期间接受股骨近端骨折手术的1077例60岁及以上患者进行了评估。通过病历审查提取了Charlson合并症指数中测量的合并症。结局指标为TTS、术后并发症和LOS。
大多数患者为白人，平均年龄85岁。一半患者居住在养老院或辅助生活设施中。Charlson平均评分为3.06，养老院居民的评分显著高于社区居民（3.4对2.8；P <.0001）。痴呆是最常见的合并症。基于Charlson评分，LOS或TTS没有差异。总体并发症发生率为44%，谵妄是最常见的术后并发症。外周血管疾病、实体瘤病史和消化性溃疡疾病可预测谵妄发生率。Charlson评分可预测并发症风险，每增加1分，比值比为1.12。
虚弱和合并症使该髋部骨折人群面临围手术期不良预后的高风险。本研究表明，在GFC护理模式中，合并症负担并未影响TTS和LOS，但确实可预测术后并发症发生率。
