Groff Hannah, Kheir Michael M, George Jaiben, Azboy Ibrahim, Higuera Carlos A, Parvizi Javad
Rothman Institute at Thomas Jefferson University, PA, USA.
Cleveland Clinic, OH, USA.
Hip Int. 2020 Mar;30(2):204-209. doi: 10.1177/1120700019835160. Epub 2019 Mar 25.
Although there are numerous studies reporting early mortality after hip fracture, the incidence and aetiology of in-hospital mortality following hip fractures is largely unknown. This study aimed to determine the causes and the incidence of in-hospital mortality in patients with a hip fracture who received surgical treatment.
This was a multi-institutional retrospective study identifying 2464 consecutive patients >65 years of age who were treated for a hip fracture from 2000 to 2016 at 2 institutions. Revision surgeries were excluded. An electronic query followed by manual chart review was performed to collect patient demographics, Charlson comorbidity index (CCI), type of anaesthesia, and cause of death.
The overall in-hospital mortality rate for patients undergoing surgical intervention for an acute hip fracture was 3.0% (75/2464). The most common causes of death in descending order were: respiratory failure ( = 26), cardiac failure ( 13), multiorgan failure ( 6), septic shock ( 6), pulmonary embolism ( 5), end stage renal disease ( 5) and others ( 14). In-hopsital mortality was associated with older age ( 0.001) and higher CCI scores ( 0.001). There was no association with gender ( 0.165), type of anaesthesia ( 0.497), extracapsular versus intracapsular fracture ( 0.627), pathologic versus non-pathologic fracture (0.799), or body mass index ( 0.781).
This study demonstrated that hip fracture patients are at relatively high risk of in-hospital mortality following surgical intervention with a high proportion of patients succumbing to respiratory failure. The findings compel us to investigate strategies that can minimize mortality related to respiratory failure in this patient population such as minimising opioid use, early mobilisation, and implementing greater respiratory monitoring.
尽管有大量研究报告髋部骨折后的早期死亡率，但髋部骨折后院内死亡率的发生率和病因在很大程度上尚不清楚。本研究旨在确定接受手术治疗的髋部骨折患者的院内死亡原因及发生率。
这是一项多机构回顾性研究，纳入了2000年至2016年在两家机构接受髋部骨折治疗的2464例连续65岁以上患者。排除翻修手术。通过电子查询并随后进行人工病历审查来收集患者人口统计学资料、查尔森合并症指数（CCI）、麻醉类型和死亡原因。
接受急性髋部骨折手术干预患者的总体院内死亡率为3.0%（75/2464）。按降序排列，最常见的死亡原因依次为：呼吸衰竭（=26）、心力衰竭（13）、多器官衰竭（6）、感染性休克（6）、肺栓塞（5）、终末期肾病（5）及其他（14）。院内死亡率与年龄较大（0.001）和较高的CCI评分（0.001）相关。与性别（0.165）、麻醉类型（0.497）、囊外骨折与囊内骨折（0.627）、病理性骨折与非病理性骨折（0.799）或体重指数（0.781）无关。
本研究表明，髋部骨折患者在手术干预后院内死亡风险相对较高，其中很大一部分患者死于呼吸衰竭。这些发现促使我们研究可将该患者群体中与呼吸衰竭相关的死亡率降至最低的策略，如尽量减少阿片类药物使用、早期活动及加强呼吸监测。
