Bokshan Steven L, Marcaccio Stephen E, Blood Travis D, Hayda Roman A
Department of Orthopaedics, Warren Alpert Medical School of Brown University, Providence, RI, United States.
Department of Orthopaedics, Warren Alpert Medical School of Brown University, Providence, RI, United States.
Injury. 2018 Mar;49(3):685-690. doi: 10.1016/j.injury.2018.02.004. Epub 2018 Feb 6.
Hip fractures account for a significant disease burden in the Unites States. With an aging population, this disease burden is expected to increase in the upcoming decades.
This represents a retrospective cohort study to assess mortality following hip fracture in the octogenarian and nonagenarian populations. Odds ratios for postoperative mortality were constructed using normalized patients from United States Social Security death tables. Kaplan Meier analysis and binary logistic regression were used to assess the impact of surgical delay and medical comorbidity (measured by the Carlson Comorbidity Index (CCI)) on postoperative mortality.
189 octogenarians and 95 nonagenarians were included. One-year mortality was nearly three times higher for both the octogenarians (OR: 3.1) and nonagenarians (OR: 3.14), and returned to that of the normal population 4 years post-op for octogenarians and 5 years post-op for nonagenarians. Higher preoperative medical comorbidity (CCI) was associated with higher post-op mortality for both octogenarians (log rank = 0.026) and nonagenarians (log rank = 0.034). A 48-h surgical delay resulted in significantly increased postoperative mortality among healthy patients (CCI of 0 or 1, OR: 18.1), but was protective for patients with significant medical comorbidity (CCI ≥ 3). Age, preoperative CCI, and 48-h surgical delay were all independent predictors of 1-year post-op mortality.
Following hip fracture, there is a 3-fold increase in mortality for octogenarians and nonagenarians at 1 year post-op. A 48-h surgical delay significantly increased mortality for healthier patients but was protective against mortality for sicker patients.
髋部骨折在美国造成了重大的疾病负担。随着人口老龄化，预计在未来几十年这种疾病负担将会增加。
这是一项回顾性队列研究，旨在评估八旬和九旬老人髋部骨折后的死亡率。使用来自美国社会保障死亡表的标准化患者构建术后死亡率的比值比。采用Kaplan Meier分析和二元逻辑回归来评估手术延迟和医疗合并症（通过卡尔森合并症指数（CCI）衡量）对术后死亡率的影响。
纳入了189名八旬老人和95名九旬老人。八旬老人（比值比：3.1）和九旬老人（比值比：3.14）的1年死亡率几乎高出三倍，八旬老人术后4年、九旬老人术后5年死亡率恢复到正常人群水平。术前较高的医疗合并症（CCI）与八旬老人（对数秩检验 = 0.026）和九旬老人（对数秩检验 = 0.034）术后较高的死亡率相关。48小时的手术延迟导致健康患者（CCI为0或1，比值比：18.1）术后死亡率显著增加，但对有严重医疗合并症（CCI≥3）的患者具有保护作用。年龄、术前CCI和48小时手术延迟均为术后1年死亡率的独立预测因素。
髋部骨折后，八旬和九旬老人术后1年死亡率增加了3倍。48小时的手术延迟显著增加了较健康患者的死亡率，但对病情较重的患者具有保护作用，可降低死亡率。
