Chatterton B D, Moores T S, Ahmad S, Cattell A, Roberts P J
Department of Trauma and Orthopaedics, Royal Stoke University Hospital, Newcastle Road, Stoke-on-Trent, ST4 6QG, UK.
Bone Joint J. 2015 Feb;97-B(2):246-51. doi: 10.1302/0301-620X.97B2.35248.
The aims of this study were to identify the early in-hospital mortality rate after hip fracture, identify factors associated with this mortality, and identify the cause of death in these patients. A retrospective cohort study was performed on 4426 patients admitted to our institution between the 1 January 2006 and 31 December 2013 with a hip fracture (1128 male (26%), mean age 82.0 years (60 to 105)). Admissions increased annually, but despite this 30-day mortality decreased from 12.1% to 6.5%; 77% of these were in-hospital deaths. Male gender (odds ratio (OR) 2.0, 95% confidence interval (CI) 1.3 to 3.0), increasing age (age ≥ 91; OR 4.1, 95% CI 1.4 to 12.2) and comorbidity (American Society of Anesthesiologists grades 3 to 5; OR 4.2, 95% CI 2.0 to 8.7) were independently and significantly associated with increased odds of in-hospital mortality. From 220 post-mortem reports, the most common causes of death were respiratory infections (35%), ischaemic heart disease (21%), and cardiac failure (13%). A sub-group of hip fracture patients at highest risk of early death can be identified with these risk factors, and the knowledge of the causes of death can be used to inform service improvements and the development of a more didactic care pathway, so that multidisciplinary intervention can be focused for this sub-group in order to improve their outcome.
本研究的目的是确定髋部骨折后早期院内死亡率，确定与该死亡率相关的因素，并确定这些患者的死亡原因。对2006年1月1日至2013年12月31日期间入住我院的4426例髋部骨折患者进行了一项回顾性队列研究（1128例男性（26%），平均年龄82.0岁（60至105岁））。入院人数逐年增加，但尽管如此，30天死亡率从12.1%降至6.5%；其中77%为院内死亡。男性（比值比（OR）2.0，95%置信区间（CI）1.3至3.0）、年龄增加（年龄≥91岁；OR 4.1，95%CI 1.4至12.2）和合并症（美国麻醉医师协会3至5级；OR 4.2，95%CI 2.0至8.7）与院内死亡几率增加独立且显著相关。从220份尸检报告来看，最常见的死亡原因是呼吸道感染（35%）、缺血性心脏病（21%）和心力衰竭（13%）。通过这些风险因素可以识别出早期死亡风险最高的髋部骨折患者亚组，而死亡原因的相关知识可用于指导服务改进和制定更具指导性的护理路径，以便针对该亚组进行多学科干预，从而改善其预后。
