Koso Riikka E, Sheets Charles, Richardson William J, Galanos Anthony N
1 UT Health San Antonio, San Antonio, TX, USA.
2 University of St Augustine, Augustine, FL, USA.
Am J Hosp Palliat Care. 2018 Apr;35(4):612-619. doi: 10.1177/1049909117725057. Epub 2017 Aug 21.
Hip fracture in the elderly patients is associated with increased morbidity and mortality. There is great need for advance care planning should a patient fail to rehabilitate or experience an adverse event during or after recovery. This study was performed to evaluate for palliative care consultation and changes in code status and/or advance directives in elderly patients with hip fracture.
We performed a retrospective review of 186 consecutive patients aged 65 years and older with a hip fracture due to a low-energy fall who underwent surgery at a large academic institution between August 1, 2013, and September 1, 2014. Risk factors assessed were patient demographics, home status, mobility, code status, comorbidities, medications, and hospitalizations prior to injury. Outcomes of interest included palliative care consultation, complications, mortality, and most recent code status, mobility, and home.
About 186 patients with hip fractures were included. Three patients died, and 12 (6.5%) sustained major complications during admission. Nearly one-third (51 patients) died upon final follow-up approximately 1.5 years after surgery. Of the patients who died, palliative care consulted on 6 (11.8%) during initial admission. Eleven (21.6%) were full code at death. Three patients underwent cardiopulmonary resuscitation (CPR) and 1 underwent massive transfusion and extracorporeal membrane oxygenation prior to changing their code status to do not attempt resuscitation.
Hip fracture in elderly patients is an important opportunity to reassess the patient's personal health-care priorities. Advance directives, goals of care, and code status documentation should be updated in all elderly patients with hip fracture, should the patient's health decompensate.
老年患者髋部骨折与发病率和死亡率增加相关。如果患者在康复过程中未能康复或在恢复期间或之后经历不良事件，则迫切需要进行预先护理计划。本研究旨在评估老年髋部骨折患者的姑息治疗咨询以及代码状态和/或预先指示的变化。
我们对2013年8月1日至2014年9月1日期间在一家大型学术机构接受手术的186例65岁及以上因低能量跌倒导致髋部骨折的连续患者进行了回顾性研究。评估的风险因素包括患者人口统计学、家庭状况、活动能力、代码状态、合并症、药物治疗以及受伤前的住院情况。感兴趣的结果包括姑息治疗咨询、并发症、死亡率以及最近的代码状态、活动能力和家庭情况。
纳入了约186例髋部骨折患者。3例患者死亡，12例（6.5%）在住院期间发生严重并发症。在术后约1.5年的最终随访中，近三分之一（51例）患者死亡。在死亡患者中，6例（11.8%）在初次入院时接受了姑息治疗咨询。11例（21.6%）在死亡时为完全复苏状态。3例患者接受了心肺复苏（CPR），1例在将代码状态改为不尝试复苏之前接受了大量输血和体外膜肺氧合。
老年患者髋部骨折是重新评估患者个人医疗保健优先事项的重要契机。所有老年髋部骨折患者，如果其健康状况恶化，应更新预先指示、护理目标和代码状态记录。
