Hsu Raymond Y, Lee Yoojin, Hayda Roman, DiGiovanni Christopher W, Mor Vincent, Bariteau Jason T
Department of Orthopaedic Surgery, Brown University, Suite 200, 2 Dudley Street, Providence, RI 02903. E-mail address for R.Y. Hsu:
Center for Gerontology and Health Care Research, School of Public Health, Brown University, Box G-S121-6, 121 South Main Street, Providence, RI 02912.
J Bone Joint Surg Am. 2015 Nov 4;97(21):1748-55. doi: 10.2106/JBJS.O.00095.
The purpose of this study was to examine the incidence of adverse events in elderly patients who required inpatient admission after sustaining an ankle fracture and to consider these data in relation to geriatric hip fracture and other geriatric patient admissions.
A retrospective cohort study of patients admitted with an ankle fracture, a hip fracture, or any other diagnosis was performed with the Medicare Part A database for 2008. The primary outcome measure was the one-year mortality rate, examined with multivariate analysis factoring for both patient age and preexisting comorbidity. Secondary outcome measures analyzed additional morbidity as reflected by length of stay, discharge disposition, readmissions, and medical complications.
There were 19,648 patients with ankle fractures, 193,980 patients with hip fractures, and 5,801,831 patients with other admitting diagnoses. Significant differences (p < 0.001) were noted in both age and comorbidity status between the group with ankle fractures and the group with hip fractures. The one-year mortality after admission was 11.9% for patients with ankle fracture, 28.2% for patients with hip fracture, and 21.5% for patients with any other admission. Upon using multivariate analysis to account for both age and comorbidity, the hazard ratio for one-year mortality associated with fracture was 1.088 for patients with hip fracture and 0.557 for patients with ankle fracture.
Even after selecting for admitted patients and accounting for both age and comorbidity, geriatric patients with ankle fractures were found to have a lower one-year morbidity compared with geriatric patients who had sustained a hip fracture or alternative admitting diagnoses. Geriatric patients with ankle fractures are likely healthier and more active in ways that are not captured by simply accounting for age and comorbidity. These findings may support more aggressive definitive management of such injuries in this population.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
本研究旨在调查踝关节骨折后需住院治疗的老年患者不良事件的发生率，并结合老年髋部骨折及其他老年患者住院情况对这些数据进行分析。
利用2008年医疗保险A部分数据库，对因踝关节骨折、髋部骨折或其他诊断入院的患者进行回顾性队列研究。主要结局指标为一年死亡率，采用多因素分析，对患者年龄和并存疾病进行校正。次要结局指标分析住院时间、出院去向、再入院情况及医疗并发症所反映的其他发病率。
共有19648例踝关节骨折患者、193980例髋部骨折患者及5801831例其他诊断入院患者。踝关节骨折组与髋部骨折组在年龄和并存疾病状况方面均存在显著差异（p<0.001）。踝关节骨折患者入院后一年死亡率为11.9%，髋部骨折患者为28.2%，其他诊断入院患者为21.5%。采用多因素分析对年龄和并存疾病进行校正后，髋部骨折患者一年死亡风险比为1.088，踝关节骨折患者为0.557。
即使在选择入院患者并对年龄和并存疾病进行校正后，与髋部骨折或其他诊断入院的老年患者相比，踝关节骨折的老年患者一年发病率仍较低。踝关节骨折的老年患者可能更健康、活动能力更强，而这些情况无法单纯通过年龄和并存疾病来体现。这些发现可能支持对此类人群的此类损伤采取更积极的确定性治疗。
预后性III级。有关证据水平的完整描述，请参阅《作者须知》。
