老年人肱骨骨折的死亡率：手术治疗有影响吗？
Mortality Rates of Humerus Fractures in the Elderly: Does Surgical Treatment Matter?
作者信息
Lander Sarah T, Mahmood Bilal, Maceroli Michael A, Byrd Jonathan, Elfar John C, Ketz John P, Nikkel Lucas E
机构信息
Department of Orthopaedics and Rehabilitation, University of Rochester, Rochester, NY.
Department of Orthopaedics, Emory University, Atlanta, GA.
出版信息
J Orthop Trauma. 2019 Jul;33(7):361-365. doi: 10.1097/BOT.0000000000001449.
INTRODUCTION
Multiple studies have shown the impact of hip fractures on geriatric mortality. Few evaluate mortality after proximal humerus (PH) or distal humerus (DH) fractures, and fewer determine differences in mortality based on management. We aim to evaluate a statewide cohort of elderly patients with PH or DH fractures to evaluate mortality, length of stay, discharge data, readmission, and differences based on management.
METHODS
The New York Statewide Planning and Research Cooperative System database was used to identify patients 60 years and older admitted with a PH or DH fracture. Patient demographics, including age, gender, sex, race, weight, and insurance status, along with comorbid conditions using the Charlson Comorbidity Index, were determined. Seven-day, 30-day, and 1-year mortality was determined for operative and nonoperative cohorts. Logistic regression determined the competing risk of mortality when controlling for patient demographics, comorbid conditions, and treatment.
RESULTS
Forty-two thousand five hundred eleven PH and 7654 DH fractures were evaluated. PH fractures had higher mortality than DH. Nonoperative treatment occurred in 76.2% of PH fractures and 53% of DH fractures. There were more comorbid conditions, longer length of stay, and higher mortality at 7 days, 30 days, and 1 year in patients treated nonoperatively. After controlling for patient demographics and comorbid conditions, there was no difference in mortality between PH and DH fractures, but operative treatment for either PH or DH was associated with lower mortality at all time points.
DISCUSSION
Fewer PH than DH fractures were treated operatively. Operative treatment was associated with improved survival in patients hospitalized with PH or DH fracture even after controlling for patient demographic and comorbid factors.
LEVEL OF EVIDENCE
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
引言
多项研究表明髋部骨折对老年患者死亡率的影响。很少有研究评估肱骨近端（PH）或肱骨远端（DH）骨折后的死亡率，更少有人根据治疗方式确定死亡率的差异。我们旨在评估全州范围内患有PH或DH骨折的老年患者队列，以评估死亡率、住院时间、出院数据、再入院情况以及基于治疗方式的差异。
方法
使用纽约全州规划与研究合作系统数据库识别60岁及以上因PH或DH骨折入院的患者。确定患者的人口统计学特征，包括年龄、性别、种族、体重和保险状况，以及使用查尔森合并症指数的合并症情况。确定手术组和非手术组的7天、30天和1年死亡率。逻辑回归分析在控制患者人口统计学特征、合并症情况和治疗方式时死亡率的竞争风险。
结果
共评估了42511例PH骨折和7654例DH骨折。PH骨折的死亡率高于DH骨折。76.2%的PH骨折和53%的DH骨折采用非手术治疗。非手术治疗的患者合并症更多、住院时间更长，且在7天、30天和1年时死亡率更高。在控制患者人口统计学特征和合并症情况后，PH和DH骨折的死亡率没有差异，但PH或DH骨折的手术治疗在所有时间点都与较低的死亡率相关。
讨论
接受手术治疗的PH骨折比DH骨折少。即使在控制患者人口统计学特征和合并症因素后，PH或DH骨折住院患者的手术治疗与生存率提高相关。
证据水平
预后水平III。有关证据水平的完整描述，请参阅作者指南。
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