Beaupre Lauren A, Carson Jeffrey L, Noveck Helaine, Magaziner Jay
Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada.
Rutgers Biomedical Health Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey.
J Am Geriatr Soc. 2015 Aug;63(8):1640-4. doi: 10.1111/jgs.13535. Epub 2015 Jul 22.
To compare risk-adjusted differences between men and women 30 and 60 days after hip fracture surgery in not walking, ability to return home in a community-dwelling subset, not walking in a nursing home resident subset, and mortality within 60 days.
Cohort study.
Data were from a randomized clinical trial that compared two blood transfusion protocols after hip fracture.
Individuals with hip fracture (N = 2,016; 489 (24%) male).
Walking, dwelling, and mortality were determined in telephone follow-up 30 and 60 days after randomization, which occurred within 3 days of surgery. Sex differences for each outcome were compared using univariate and multivariate regression adjusting for potential confounders.
Men were younger (P < .001) and more likely to have comorbidity (P = .003) than women at the time of hip fracture and to die within 60 days, even after risk adjustment (odds ratio (OR) = 1.76, 95% confidence interval (CI) = 1.15-2.69). After risk adjustment, male survivors were as likely as female survivors not to walk (OR = 1.03, 95% CI = 0.78-1.34) and no less likely to return home (OR = 0.90, 95% CI = 0.69-1.17) 60 days after hip fracture. No differences were noted between male and female nursing home residents in not walking within 60 days (OR = 0.95, 95% CI = 0.32-2.86).
Although men experience higher mortality, male survivors can expect recovery of walking ability similar to that of female survivors and are as likely to return to community living.
比较髋部骨折手术后30天和60天时,男性和女性在未行走、社区居住亚组中回家能力、养老院居住亚组中未行走以及60天内死亡率方面经风险调整后的差异。
队列研究。
数据来自一项比较髋部骨折后两种输血方案的随机临床试验。
髋部骨折患者(N = 2016;489名(24%)男性)。
在随机分组后30天和60天进行电话随访,确定行走、居住情况和死亡率,随机分组在手术3天内进行。使用单变量和多变量回归比较各结局的性别差异,并对潜在混杂因素进行调整。
髋部骨折时,男性比女性更年轻(P <.001),合并症更多(P =.003),且即使经过风险调整,60天内死亡的可能性也更高(优势比(OR)= 1.76,95%置信区间(CI)= 1.15 - 2.69)。经过风险调整后,男性幸存者与女性幸存者在髋部骨折60天后不行走的可能性相同(OR = 1.03,95% CI = 0.78 - 1.34),回家的可能性也不低(OR = 0.90,95% CI = 0.69 - 1.17)。在60天内未行走方面,男性和女性养老院居住者之间没有差异(OR = 0.95,95% CI = 0.32 - 2.86)。
尽管男性死亡率较高,但男性幸存者的行走能力恢复情况与女性幸存者相似,且回归社区生活的可能性相同。