Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore.
Centre of Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore.
Osteoporos Int. 2019 Dec;30(12):2477-2483. doi: 10.1007/s00198-019-05139-8. Epub 2019 Aug 26.
The aim of this study was to investigate the association of surgical delay and comorbidities with the risk of mortality after hip fracture surgeries. We found that CCI was the dominant factor in predicting both short- and long-term mortality, and its effect is vital in the prognostication of survivorship.
Hip fracture is a growing concern and a delay in surgery is often associated with a poorer outcome. We hypothesized that a higher Charlson Comorbidity Index (CCI) portends greater risk of mortality than a delay in surgery. Our aim was to investigate the associations of surgical delay and CCI with risk of mortality and to determine the dominant predictor.
This retrospective study examines hip fracture data from a large tertiary hospital in Singapore over the period January 2013 through December 2015. Data collected included age, gender, CCI, delay of surgery, fracture patterns, and the American Society of Anaesthesiologist (ASA) score. Post-operative outcomes analyzed included mortality at inpatient, at 30 and 90 days, and at 2 years.
A total of 1004 patients with hip fractures were included in this study. Study mortality rates were 1.1% (n = 11) during in-hospital admission, 1.8% (n = 18) at 30 days, 2.7% (n = 27) at 90 days, and 13.3% (n = 129) at 2 years. Lost to follow-up rate at 2 years was 3.3%. We found that CCI was consistently the dominant factor in predicting both short- and long-term mortality. A CCI score of 5 was identified as the inflection point above which comorbidity at baseline presented a greater risk of mortality than a delay in surgery.
Our analysis showed that CCI is the dominant predictor of both short- and long-term mortality compared with delay in surgery. The effect of CCI is vital in the prognostication of mortality in patients surgically treated for hip fractures.
本研究旨在探讨手术延迟和合并症与髋部骨折手术后死亡风险的关系。我们发现，CCI 是预测短期和长期死亡率的主要因素，其对生存率的预测至关重要。
髋部骨折是一个日益严重的问题，手术延迟通常与预后不良有关。我们假设Charlson 合并症指数（CCI）越高，死亡率的风险就越高，而不是手术延迟。我们的目的是探讨手术延迟和 CCI 与死亡率风险的关系，并确定主要的预测因素。
本回顾性研究分析了新加坡一家大型三级医院 2013 年 1 月至 2015 年 12 月期间的髋部骨折数据。收集的数据包括年龄、性别、CCI、手术延迟、骨折类型和美国麻醉医师协会（ASA）评分。术后分析的结果包括住院期间、30 天和 90 天以及 2 年的死亡率。
本研究共纳入 1004 例髋部骨折患者。研究死亡率分别为住院期间 1.1%（n=11）、30 天 1.8%（n=18）、90 天 2.7%（n=27）和 2 年 13.3%（n=129）。2 年时失访率为 3.3%。我们发现，CCI 始终是预测短期和长期死亡率的主要因素。CCI 评分为 5 被确定为临界点，基线时的合并症比手术延迟更能增加死亡率的风险。
我们的分析表明，与手术延迟相比，CCI 是预测短期和长期死亡率的主要预测因素。CCI 对预测接受髋部骨折手术治疗的患者的死亡率至关重要。
