Swift Oscar, Ayub Anouska, Mathavakkannan Suresh, de Roeck Nick
Department of Trauma and Orthopaedics, Lister Hospital, East and North Hertfordshire NHS Trust, Stevenage, UK.
Department of Renal Medicine, Lister Hospital, East and North Hertfordshire NHS Trust, Stevenage, UK.
BMC Nephrol. 2016 Mar 3;17:26. doi: 10.1186/s12882-016-0234-6.
Neck of femur fractures are associated with high mortality and have increased prevalence in dialysis patients. Delays in operating on dialysis patients can occur as a result of logistical or medical issues; it has previously been shown that delays on operating on neck of femur fractures in the general population results in increased mortality.
Medical records of 27 dialysis patients admitted to a large district general hospital in the UK with a fractured neck of femur between January 2009 and January 2014 were analysed alongside records of 27 age and sex-matched non-dialysis patients. Fisher's exact test and the unpaired t test were applied to data to explore outcomes. Odds ratio was also used to compare mortality between the dialysis and non-dialysis groups.
Thirty-day mortality amongst dialysis patients was 22 %, compared to 7 % in the non-dialysis cohort. One-year mortality amongst dialysis patients was 70 %, compared to 15 % in the non-dialysis cohort (odds ratio 13.7 (3.56-52.4, 95 % confidence interval; p = 0.0001)). Average length of survival in dialysis patients overall was 311 days; average length of survival if the patient was operated on within 48 h of admission was 450 days (192-708 days, 95 % confidence interval) and was 224 days (45-402, 95 % confidence interval) if operated on after more than 48 h of admission (p = 0.16).
Dialysis patients had higher post-operative mortality than the non-dialysis cohort. Odds ratio for death was significantly greater at one-year in the cohort of dialysis patients compared to the non-dialysis patients. Delay to operation amongst the dialysis patient cohort did not contribute significantly to mortality in this study. The higher rates of coronary artery disease, diabetes mellitus and malignancy may confound mortality amongst patients on dialysis who sustain a fractured neck of femur. Limitations of this study included small patient numbers, data from only one centre being used, and some missing data for certain patients.
股骨颈骨折与高死亡率相关，且在透析患者中的患病率有所增加。由于后勤或医疗问题，透析患者的手术可能会延迟；此前研究表明，普通人群中股骨颈骨折手术延迟会导致死亡率上升。
分析了2009年1月至2014年1月期间入住英国一家大型地区综合医院的27例股骨颈骨折透析患者的病历，并与27例年龄和性别匹配的非透析患者的病历进行对照。采用Fisher精确检验和非配对t检验对数据进行分析以探究结果。还使用比值比来比较透析组和非透析组之间的死亡率。
透析患者的30天死亡率为22%，而非透析队列中的这一比例为7%。透析患者的一年死亡率为70%，非透析队列中的这一比例为15%（比值比为13.7（3.56 - 52.4，95%置信区间；p = 0.0001））。透析患者的总体平均生存时长为311天；若患者在入院后48小时内接受手术，平均生存时长为450天（192 - 708天，95%置信区间），若在入院超过48小时后接受手术，则为224天（45 - 402天，95%置信区间）（p = 0.16）。
透析患者术后死亡率高于非透析队列。与非透析患者相比，透析患者队列中一年时的死亡比值比显著更高。在本研究中，透析患者队列的手术延迟对死亡率没有显著影响。较高的冠状动脉疾病、糖尿病和恶性肿瘤发病率可能会混淆股骨颈骨折透析患者的死亡率。本研究的局限性包括患者数量少、仅使用了来自一个中心的数据以及某些患者存在一些缺失数据。
