老年髋部骨折患者综合老年骨科治疗后的住院并发症及危险因素

Complications during hospitalization and risk factors in elderly patients with hip fracture following integrated orthogeriatric treatment.

作者信息

Folbert E C, Hegeman J H, Gierveld R, van Netten J J, Velde D van der, Ten Duis H J, Slaets J P

机构信息

Department of Trauma Surgery, Ziekenhuisgroep Twente, Almelo-Hengelo, The Netherlands.

Department of Finance and Organization, Ziekenhuisgroep Twente, Almelo-Hengelo, The Netherlands.

出版信息

Arch Orthop Trauma Surg. 2017 Apr;137(4):507-515. doi: 10.1007/s00402-017-2646-6. Epub 2017 Feb 23.

DOI:10.1007/s00402-017-2646-6

PMID:28233062

Abstract

INTRODUCTION

This study aimed to evaluate the incidence of complications in elderly patients with a hip fracture following integrated orthogeriatric treatment. To discover factors that might be adjusted, in order to improve outcome in those patients, we examined the association between baseline patient characteristics and a complicated course.

METHODS

We included patients aged 70 years and older with a hip fracture, who were treated at the Centre for Geriatric Traumatology (CvGT) at Ziekenhuisgroep Twente (ZGT) Almelo, the Netherlands between April 2011 and October 2013. Data registration was carried out using the clinical pathways of the CvGT database. Based on the American Society of Anesthesiologists (ASA) score, patients were divided into high-risk (HR, ASA 3 ≥, n = 341) and low-risk (LR, ASA 1-2, n = 111) groups and compared on their recovery. Multivariate logistic regression was used to identify risk factors for a complicated course.

RESULTS

The analysis demonstrated that 49.6% (n = 224) of the patients experienced a complicated course with an in-hospital mortality rate of 3.8% (n = 17). In 57.5% (n = 196) of the HR patients, a complicated course was seen compared to 25.2% (n = 28) of the LR patients. The most common complications in both groups were the occurrence of delirium (HR 25.8% vs. LR 8.1%, p ≤ 0.001), anemia (HR 19.4% vs. LR 6.3%, p = 0.001), catheter-associated urinary tract infections (CAUTIs) (HR 10.6% vs. LR 7.2%, p = 0.301) and pneumonia (HR 10.9% vs. LR 5.4%, p = 0.089). Independent risk factors for a complicated course were increasing age (OR 1.04, 95% CI 1.01-1.07, p = 0.023), delirium risk VMS Frailty score (OR 1.57, 95% CI 1.04-2.37, p = 0.031) and ASA score ≥3 (OR 3.62, 95% CI 2.22-5.91, p ≤ 0.001).

CONCLUSIONS

After integrated orthogeriatric treatment, a complicated course was seen in 49.6% of the patients with a hip fracture. The in-hospital mortality rate was 3.8%. Important risk factors for a complicated course were increasing age, poor medical condition and delirium risk VMS Frailty score. Awareness of risk factors that affect the course during admission can be useful in optimizing care and outcomes. In the search for possible areas for improvement in care, targeted preventive measures to mitigate delirium, and healthcare-associated infections (HAIs), such as CAUTIs and pneumonia are important.

摘要

引言

本研究旨在评估老年髋部骨折患者接受综合老年创伤治疗后并发症的发生率。为了找出可能需要调整的因素，以改善这些患者的治疗结果，我们研究了患者基线特征与复杂病程之间的关联。

方法

我们纳入了2011年4月至2013年10月在荷兰阿尔梅洛的特温特医院集团（ZGT）老年创伤中心（CvGT）接受治疗的70岁及以上髋部骨折患者。使用CvGT数据库的临床路径进行数据登记。根据美国麻醉医师协会（ASA）评分，将患者分为高危（HR，ASA 3级及以上，n = 341）和低危（LR，ASA 1 - 2级，n = 111）组，并比较他们的康复情况。采用多因素逻辑回归分析确定复杂病程的危险因素。

结果

分析表明，49.6%（n = 224）的患者经历了复杂病程，住院死亡率为3.8%（n = 17）。HR组中57.5%（n = 196）的患者出现了复杂病程，而LR组为25.2%（n = 28）。两组中最常见的并发症是谵妄的发生（HR组25.8% vs. LR组8.1%，p≤0.001）、贫血（HR组19.4% vs. LR组6.3%，p = 0.001）、导管相关性尿路感染（CAUTIs）（HR组10.6% vs. LR组7.2%，p = 0.301）和肺炎（HR组10.9% vs. LR组5.4%，p = 0.089）。复杂病程的独立危险因素包括年龄增加（OR 1.04，95% CI 1.01 - 1.07，p = 0.023）、谵妄风险VMS虚弱评分（OR 1.57，95% CI 1.04 - 2.37，p = 0.031）和ASA评分≥3（OR 3.62，95% CI 2.22 - 5.91，p≤0.001）。

结论

综合老年创伤治疗后，49.6%的髋部骨折患者出现了复杂病程。住院死亡率为3.8%。复杂病程的重要危险因素包括年龄增加、身体状况差和谵妄风险VMS虚弱评分。了解入院期间影响病程的危险因素有助于优化护理和治疗结果。在寻找可能的护理改进领域时，针对性的预防措施以减轻谵妄以及医疗相关感染（HAIs），如CAUTIs和肺炎非常重要。