Flikweert E R, Wendt K W, Diercks R L, Izaks G J, Landsheer D, Stevens M, Reininga I H F
Department of Surgery-Traumatology, University Medical Center Groningen, UMCG, University of Groningen, P.O. Box 30001, 9700 RB, Groningen, The Netherlands.
Department of Orthopedic Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Eur J Trauma Emerg Surg. 2018 Aug;44(4):573-580. doi: 10.1007/s00068-017-0826-2. Epub 2017 Aug 9.
Surgery for hip fractures is frequently followed by complications that hinder the rehabilitation of patients. The aim of this study was to describe the incidence rate and type of complications, including mortality, after hip fracture surgery, and to identify the risk factors of these complications that may be amenable to prevention.
Prospective cohort study of all consecutive patients aged ≥60 treated for a hip fracture at University Medical Center Groningen between July 2009 and June 2013. All patients were treated in a comprehensive multidisciplinary care pathway. Logistic regression analyses were used to investigate which variables were significant risk factors for the occurrence of complications. Additional analyses were conducted to investigate whether the independent variables were significant risk factors for several specific complications and mortality.
The study population consisted of 479 patients with a mean age of 78.4 (SD 9.5) years; 33% were men. The overall complication rate was 75%. Delirium was the complication seen most frequently (19%); the incidence of surgical complications was 9%. Most risk factors for complications were not preventable (high comorbidity rate, high age and dependent living situation). However, general anesthesia (OR 1.51; 95% CI 0.97-2.35) and delay in surgery (OR 3.16; 95% CI 1.43-6.97) may be risk factors that can potentially be prevented. Overall, the mortality risk was not higher in patients with a complication, but delirium and pneumonia were risk factors for mortality.
The overall complication rate after hip fracture surgery was high. Only few complications were potentially preventable.
髋部骨折手术后常伴有并发症，这阻碍了患者的康复。本研究的目的是描述髋部骨折手术后并发症的发生率和类型，包括死亡率，并确定这些并发症中可能可预防的危险因素。
对2009年7月至2013年6月期间在格罗宁根大学医学中心接受髋部骨折治疗的所有连续年龄≥60岁的患者进行前瞻性队列研究。所有患者均在综合多学科护理路径下接受治疗。采用逻辑回归分析来研究哪些变量是并发症发生的显著危险因素。还进行了额外分析，以研究自变量是否是几种特定并发症和死亡率的显著危险因素。
研究人群包括479名患者，平均年龄78.4（标准差9.5）岁；33%为男性。总体并发症发生率为75%。谵妄是最常见的并发症（19%）；手术并发症发生率为9%。大多数并发症的危险因素是不可预防的（高合并症发生率、高龄和依赖生活状况）。然而，全身麻醉（比值比1.51；95%置信区间0.97 - 2.35）和手术延迟（比值比3.16；95%置信区间1.43 - 6.97）可能是潜在可预防的危险因素。总体而言，有并发症的患者的死亡风险并不更高，但谵妄和肺炎是死亡的危险因素。
髋部骨折手术后的总体并发症发生率较高。只有少数并发症是潜在可预防的。
