低能量近端股骨骨折男性患者1年死亡率升高及基于年龄调整的Charlson合并症指数的亚组分析
Elevated 1-Year Mortality Rate in Males Sustaining Low-Energy Proximal Femur Fractures and Subgroup Analysis Utilizing Age-Adjusted Charlson Comorbidity Index.
作者信息
Schultz Kyle A, Westcott Benjamin A, Barber Kimberly R, Sandrock Todd A
机构信息
Department of Orthopedics, Ascension Genesys Hospital, Grand Blanc, MI, USA.
Department of Clinical & Academic Research, Ascension Genesys Hospital, Grand Blanc, MI, USA.
出版信息
Geriatr Orthop Surg Rehabil. 2020 Jan 20;11:2151459319898644. doi: 10.1177/2151459319898644. eCollection 2020.
INTRODUCTION
Low-energy proximal femur fractures are common in the aging population and the ability to identify patients at increased mortality risk provides surgeons information to improve informed decision-making with patients and families. We evaluated for gender differences in 1-year mortality after sustaining low-energy proximal femur fractures with subgroup analysis to identify the impact of fracture location, age, and comorbidities on mortality.
MATERIALS AND METHODS
Patients ≥40 years of age sustaining a low-energy proximal femur fracture identified at our institution between January 1, 2014, and December 31, 2017. and codes were used to identify comorbidities for calculation of the age-adjusted Charlson comorbidity index (ACCI). The county clerk database was searched to identify mortality within 1 year of injury. One-year mortality rates were calculated and multiple comparisons were made between genders controlling for age, fracture location, and/or ACCI.
RESULTS
Women presented with low-energy proximal femur fractures at a rate of almost 3:1 to men at our institution ( = .001). Men demonstrated a significantly increased ACCI at presentation (5.35 ± 2.55 vs 4.86 ± 1.77, = .03). Men had an increased 1-year mortality rate for all (31.3% vs 21.5%, = .004) and intertrochanteric (IT) fractures (36.2% vs 22.9%, = .008). Controlling for ACCI, gender, and fracture location, men demonstrated increased mortality rate with IT fractures ( = .002) and trended toward but did not reach significance with femoral neck fractures ( = .07).
DISCUSSION
Men presenting with low-energy femur fractures are at an increased mortality risk compared to women. On average, men present with an overall worse health status as identified by ACCI, which could predispose these patients not only to fractures themselves but also impair their ability to recover from injury.
CONCLUSION
Men are at an increased 1-year mortality risk after sustaining proximal femur fractures.
引言
低能量型股骨近端骨折在老年人群中很常见，识别出死亡率风险增加的患者，可为外科医生提供信息，以改善与患者及其家属的共同决策。我们评估了低能量型股骨近端骨折后1年死亡率的性别差异，并进行亚组分析，以确定骨折部位、年龄和合并症对死亡率的影响。
材料与方法
纳入2014年1月1日至2017年12月31日期间在本机构确诊为低能量型股骨近端骨折且年龄≥40岁的患者。使用国际疾病分类代码识别合并症，以计算年龄调整后的查尔森合并症指数（ACCI）。通过查询县书记员数据库确定受伤后1年内的死亡率。计算1年死亡率，并在控制年龄、骨折部位和/或ACCI的情况下对性别进行多重比较。
结果
在本机构，女性出现低能量型股骨近端骨折的比例几乎是男性的3倍（P = 0.001）。男性就诊时的ACCI显著更高（5.35±2.55对4.86±1.77，P = 0.03）。男性所有骨折（31.3%对21.5%，P = 0.004）和粗隆间骨折（36.2%对22.9%，P = 0.008）的1年死亡率均更高。在控制ACCI、性别和骨折部位后，男性粗隆间骨折的死亡率增加（P = 0.002），股骨颈骨折的死亡率呈上升趋势但未达到显著水平（P = 0.07）。
讨论
与女性相比，出现低能量型股骨骨折的男性死亡率风险增加。平均而言，根据ACCI确定，男性的整体健康状况更差，这不仅可能使这些患者易发生骨折，还会损害他们从损伤中恢复的能力。
结论
男性股骨近端骨折后1年死亡率风险增加。
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