Ji Hyung-Min, Han Jun, Bae Hi-Won, Won Ye-Yeon
Department of Joint Surgery, Siheung 21C Hospital, Siheung, South Korea.
Department of Orthopedics, Ajou University School of Medicine, Suwon, South Korea.
BMC Musculoskelet Disord. 2017 Aug 30;18(1):375. doi: 10.1186/s12891-017-1738-3.
Early detection of a high-risk patient following hip fracture surgery is of paramount clinical importance. American Society of Anesthesiologists (ASA) grading is an easy and efficient index in predicting a worse outcome. The red cell distribution width (RDW) and handgrip strength, are gaining interest as a prediction tool as well. Accordingly, the objective of this study was to investigate the potential association between ASA, RDW and grip strength and detect the effects of combining RDW and grip strength for predicting early complication after hip fracture surgery in the elderly.
Eighty-three consecutive patients operated with hip fracture surgeries were identified retrospectively. Age, gender, diagnosis, RDW, handgrip strength and ASA grade were recorded. Admission to the intensive care unit (ICU), length of ICU stay, transfer to other departments, in-hospital death, and readmission were investigated as early complications. Logistic regression analysis was applied to evaluate the estimates in predicting complications, and receiver operating characteristics curves were constructed to compare the estimates and decide which method is more accurate.
After the surgery, 52% of the patients were admitted to the ICU. From the analyses, RDW and grip strength had no significant relation with each other. However, the ICU stay was correlated with RDW and grip strength but not for the ASA grade. A higher ASA grade and grip strength could independently predict ICU admission. The combination of RDW with grip strength outweighed the ASA grade in predictive ability.
The current study indicated that combining RDW and grip strength measures can be efficient and clinically relevant in predicting early postoperative complications after fragility hip fracture in the elderly. Due to the objectivity and availability of those two approaches, patient care, and functional outcomes are expected to be improved by adopting these measures in the clinical setting.
髋部骨折手术后早期发现高危患者具有至关重要的临床意义。美国麻醉医师协会（ASA）分级是预测不良预后的一种简单有效的指标。红细胞分布宽度（RDW）和握力作为预测工具也越来越受到关注。因此，本研究的目的是探讨ASA、RDW和握力之间的潜在关联，并检测将RDW和握力相结合对预测老年髋部骨折手术后早期并发症的效果。
回顾性确定83例连续接受髋部骨折手术的患者。记录年龄、性别、诊断、RDW、握力和ASA分级。将入住重症监护病房（ICU）、ICU住院时间、转至其他科室、院内死亡和再次入院作为早期并发症进行调查。应用逻辑回归分析评估预测并发症的估计值，并构建受试者工作特征曲线以比较估计值并确定哪种方法更准确。
术后，52%的患者入住ICU。分析显示，RDW和握力之间无显著相关性。然而，ICU住院时间与RDW和握力相关，而与ASA分级无关。较高的ASA分级和握力可独立预测ICU入院。RDW与握力相结合在预测能力上超过了ASA分级。
本研究表明，将RDW和握力测量相结合在预测老年髋部脆性骨折术后早期并发症方面可能有效且具有临床相关性。由于这两种方法具有客观性和可获得性，在临床环境中采用这些措施有望改善患者护理和功能结局。
