Department of Orthopaedic Surgery, University Hospital La Princesa, Universidad Autónoma de Madrid, 28006 Madrid, Spain.
Department of Orthopaedic Surgery, University Hospital La Princesa, Universidad Autónoma de Madrid, 28006 Madrid, Spain.
Injury. 2020 Apr;51 Suppl 1:S19-S24. doi: 10.1016/j.injury.2020.02.009. Epub 2020 Feb 10.
To analyze the relation between cognitive impairment on arrival at hospital in patients older than 65 years with a hip fracture, and their mortality, medical and surgical complications, and functional outcomes.
Observational study of a single-center prospective consecutive cohort of 955 patients older than 64 years diagnosed of hip fracture from December/2012 to December/2015. Average age was 86±7.2 (65-104) years and 725 (75.9%) were female. Fractures were extracapsular in 538 cases (56.3%) and intracapsular in 417 (43.7%). Patients were controlled clinically and radiographically in outpatient clinic after 1, 3, 6, and 12 months. Data about basal cognitive status, walking ability before the fracture, medical and surgical complications, functional outcomes and mortality were collected for the year following the fracture.
Bivariate analysis (Pearson, Fisher, Mann-Whitney, Wilcoxon) was applied to study statistically significant relations, and contingence coefficients (CC) were calculated.
Patients with cognitive impairment showed a higher overall mortality, (p = 0,000; CC=0,197) even after hospital discharge (p = 0.000; CC=0.198). Similarly, patients with dementia presented a higher rate of respiratory infections (p = 0,029; CC=0,093), urinary tract infections (p = 0,008; CC=0,108) and sepsis (p = 0,011; CC=0,105). On the contrary, we found no correlations between mental status and surgical complications, even for prosthesis dislocation (p = 0.136). Patients with dementia started from poorer functional situations (p = 0,000; CC=0,367) and ended follow-up with lower walking ability (p = 0,000; CC=0,43), but cognitive impairment did not relate statistically with a worse functional recovery (p = 0,304): that is, the proportion of patients who maintained their previous ability to walk was similar in both groups, those with altered mental status and those without it.
Cognitive impairment is a risk factor for mortality in patients with a hip fracture. It is also a risk factor for suffering respiratory and urinary tract infection and sepsis. These two late risks factors have not been published previously. Functional recovery is not conditioned by cognitive impairment, although further studies need to be developed to evaluate the actual role of cognitive impairment on postoperative progression of patients.
分析 65 岁以上髋部骨折患者入院时认知障碍与死亡率、医疗和手术并发症以及功能结局的关系。
这是一项对 2012 年 12 月至 2015 年 12 月间于单一中心接受治疗的、955 例 64 岁以上髋部骨折患者的前瞻性连续队列的观察性研究。患者平均年龄为 86±7.2（65-104）岁，725 例（75.9%）为女性。538 例（56.3%）为囊外骨折，417 例（43.7%）为囊内骨折。患者在门诊进行临床和影像学随访，随访时间为骨折后 1、3、6 和 12 个月。收集了骨折后 1 年内与基础认知状态、骨折前行走能力、医疗和手术并发症、功能结局和死亡率相关的数据。
采用双变量分析（Pearson、Fisher、Mann-Whitney、Wilcoxon）来研究有统计学意义的关系，并计算关联系数（CC）。
认知障碍患者的总体死亡率更高（p=0.000；CC=0.197），甚至在出院后也是如此（p=0.000；CC=0.198）。同样，痴呆患者发生呼吸道感染（p=0.029；CC=0.093）、尿路感染（p=0.008；CC=0.108）和败血症（p=0.011；CC=0.105）的风险更高。相反，我们发现精神状态与手术并发症之间没有相关性，即使是假体脱位（p=0.136）也没有相关性。痴呆患者的功能状态较差（p=0.000；CC=0.367），且在随访结束时行走能力较低（p=0.000；CC=0.43），但认知障碍与功能恢复较差没有统计学相关性（p=0.304）：即，在精神状态改变和无改变的两组患者中，保持先前行走能力的患者比例相似。
认知障碍是髋部骨折患者死亡的危险因素。它也是发生呼吸道和尿路感染和败血症的危险因素。这两个晚期风险因素以前没有报道过。功能恢复不受认知障碍的影响，但需要进一步研究来评估认知障碍对患者术后进展的实际作用。
