Orthopedic Department, Rabin Medical Center, Beilinson Hospital, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 39 Jabotinsky St., Petah Tikva, 49100, Tel Aviv, Israel.
IDF Medical Corps, Tel Aviv, Israel.
Eur J Trauma Emerg Surg. 2020 Oct;46(5):939-946. doi: 10.1007/s00068-018-0997-5. Epub 2018 Aug 23.
To define risk factors for rehospitalization following fragility hip fractures and to create a predictive model.
A retrospective cohort study of patients 65 years and older, who were treated operatively following fragility hip fractures between 01.2011 and 06.2016. Patients were allocated into two study groups based on the occurrence of recurrent hospitalizations in the year following surgery. Demographic information, comorbidities, and in-hospital characteristics were collected, as was information regarding 1-year readmissions. Multivariate analysis of factors predictive of rehospitalizations was performed, followed by a logistic regression using all predictors with p < 0.05. A stepwise backwards elimination method was used to create the predictive model.
Eight hundred and fifty-one patients were included; 369 (43.4%) had recurrent hospitalizations within the first post-operative year. Patients who were rehospitalized were more likely to be males, to use a walking aid and to live dependently. They had a higher age-adjusted Charlson's comorbidity index (ACCI) score, a higher perveance of atrial fibrillation, lower hemoglobin, worse renal function, less platelets, and longer time to surgery. Prevalence of in-hospital complications was similar. Six variables were found to independently influence the chance for readmissions: male gender, the use of a walking aid, higher ACCI score, lower hemoglobin, atrial fibrillation, and a longer surgical delay. Only the first four were found to be adequate predictors and were added to the prediction formula.
High 1-year readmission rates are seen following discharge in patients with fragility hip fractures. Addressing risk factors might aid to better rehabilitate patients and reduce morbidity.
确定脆性髋部骨折患者再住院的危险因素，并建立预测模型。
对 2011 年 1 月至 2016 年 6 月间接受手术治疗的 65 岁及以上脆性髋部骨折患者进行回顾性队列研究。根据术后 1 年内是否再次住院，将患者分为两组。收集患者的人口统计学信息、合并症和住院特征，以及 1 年再入院信息。对再住院的预测因素进行多变量分析，然后使用所有具有 p<0.05 的预测因素进行逻辑回归。采用逐步向后消除法建立预测模型。
共纳入 851 例患者，其中 369 例（43.4%）在术后第 1 年内再次住院。再住院的患者更可能为男性，需要使用助行器，且生活依赖他人。他们的年龄调整Charlson 合并症指数（ACCI）评分更高，心房颤动的患病率更高，血红蛋白水平更低，肾功能更差，血小板计数更少，手术时间更长。住院并发症的发生率相似。有 6 个变量被发现独立影响再入院的机会：男性、使用助行器、更高的 ACCI 评分、更低的血红蛋白、心房颤动和更长的手术延迟。只有前四个被发现是足够的预测因素，并被添加到预测公式中。
脆性髋部骨折患者出院后 1 年内再入院率较高。针对这些危险因素采取措施可能有助于更好地康复患者并降低发病率。
