术前甲状腺功能障碍可预测老年髋部骨折患者术后30天的并发症。
Preoperative thyroid dysfunction predicts 30-day postoperative complications in elderly patients with hip fracture.
作者信息
Ling Xi Wern, Howe Tet Sen, Koh Joyce Suang Bee, Wong Merng Koon, Ng Alvin Choong Meng
机构信息
Department of Orthopedics, Singapore General Hospital, Outram Road, Singapore.
出版信息
Geriatr Orthop Surg Rehabil. 2013 Jun;4(2):43-9. doi: 10.1177/2151458513504215.
OBJECTIVES
To investigate the relationship between thyroid function and short-term outcomes in elderly patients undergoing surgery for hip fracture.
METHODS
Patients aged >60 years admitted from July 2009 to June 2010 who underwent surgical fixation of low-energy hip fracture, excluding those with pathological or periprosthetic fracture, were enrolled in a retrospective observational cohort study. Patients were classified as having biochemically overt or subclinical hyperthyroidism or hypothyroidism, normal thyroid function, or nonclassifiable state based on preoperative thyroid-stimulating hormone and free thyroxine values. Outcome data were collected from hospital records. Biochemical thyroid dysfunction was not systematically treated. Outcomes measured were length of stay (LOS), 30-day postoperative complications, readmissions, and mortality.
RESULTS
A total of 254 patients were analyzed; 64 (25.2%) were male and mean age was 77.8 years. There were 128 (50.4%) patients with euthyroid, 68 (26.8%) nonclassifiable, 13 (5.1%) overtly hyperthyroid, 20 (7.9%) subclinically hyperthyroid, 4 (1.6%) overtly hypothyroid, and 21 (8.3%) subclinically hypothyroid. The 30-day postoperative complication rate was 38% (96 patients). The most common complication was urinary tract infection (12.6%), followed by cardiac events (8.3%) and delirium (5.5%). Patients with overt hyperthyroidism had an increased risk of complications in multivariate analysis (odds ratio 3.75, 95% confidence interval 1.10-12.84). Complications in this group were similar to those in the overall cohort. Thyroid function did not predict LOS, readmissions, or mortality.
CONCLUSION
Older patients frequently develop complications following surgery for hip fractures. This risk appears to be increased by preoperative biochemically overt hyperthyroidism. Further study is warranted to confirm this finding and to determine whether preoperative treatment improves outcomes.
目的
探讨老年髋部骨折手术患者甲状腺功能与短期预后之间的关系。
方法
对2009年7月至2010年6月收治的年龄>60岁、接受低能量髋部骨折手术内固定治疗的患者进行回顾性观察队列研究，排除病理性骨折或假体周围骨折患者。根据术前促甲状腺激素和游离甲状腺素值，将患者分为生化显性或亚临床甲状腺功能亢进或减退、甲状腺功能正常或不可分类状态。结局数据从医院记录中收集。甲状腺生化功能障碍未进行系统治疗。测量的结局指标包括住院时间（LOS）、术后30天并发症、再入院率和死亡率。
结果
共分析254例患者；64例（25.2%）为男性，平均年龄77.8岁。甲状腺功能正常者128例（50.4%），不可分类者68例（26.8%），显性甲状腺功能亢进者13例（5.1%），亚临床甲状腺功能亢进者20例（7.9%），显性甲状腺功能减退者4例（1.6%），亚临床甲状腺功能减退者21例（8.3%）。术后30天并发症发生率为38%（96例患者）。最常见的并发症是尿路感染（12.6%），其次是心脏事件（8.3%）和谵妄（5.5%）。在多变量分析中，显性甲状腺功能亢进患者并发症风险增加（比值比3.75，95%置信区间1.10 - 12.84）。该组并发症与总体队列相似。甲状腺功能不能预测住院时间、再入院率或死亡率。
结论
老年患者髋部骨折手术后常发生并发症。术前生化显性甲状腺功能亢进似乎会增加这种风险。有必要进一步研究以证实这一发现，并确定术前治疗是否能改善预后。
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