老年髋部骨折患者行半髋关节置换术的死亡率风险因素及生存率
Risk factors for mortality and survival rates in elderly patients undergoing hemiarthroplasty for hip fracture.
作者信息
Aslan Ahmet, Atay Tolga, Aydoğan Nevres Hürriyet
机构信息
Department of Orthopaedics and Traumatology, Alanya Alaaddin Keykubat University, School of Medicine, Antalya, Turkey.
Department of Orthopaedics and Traumatology, Süleyman Demirel University, School of Medicine, Isparta, Turkey.
出版信息
Acta Orthop Traumatol Turc. 2020 Mar;54(2):138-143. doi: 10.5152/j.aott.2020.02.298.
OBJECTIVE
The aim of this study was to analyze the relationship between mortality and possible risk factors in elderly patients surgically treated with hemiarthroplasty for hip fracture and to determine mortality rates and yearly survival outcome in a selected cohort.
METHODS
A total of 92 patients (51 men (55.4%) and 41 women (44.6%); mean age: 76.47 years) who underwent hemiarthroplasty for hip fracture were included into the study. The following data associated with risk factors were recorded for 92 patients: age, gender, pre-fracture activities of daily living (ADL), type of fracture, American Society of Anesthesiologists (ASA) score, therapeutic procedure, type of anesthesia, length of time after fracture until operation, postoperative mobility, and duration of hospitalization. A multivariate logistic regression test was used to evaluate the correlation between the risk factors and first- and second-year mortality rates. Third-year mortality rate after surgery was analyzed and compared with the general mortality rate in a similar population of the same age group living in the same city.
RESULTS
The mortality rate was 18.5% (17 patients) after the first-year follow-up and 25% (23 patients) after the second year. The mortality risk after hip fracture was found to be 11.7 times greater than the similar age group population in the third year. In addition, there was a significant relationship between a low (dependent) preoperative ADL score, advanced age (>80 years), male gender, high ASA score and poor ability to walk (unable to walk), and first- and second-year mortalities (p<0.05). However, no significant relationship was found between fracture type, fracture side, anesthesia type, time from fracture to surgery, or duration of hospitalization and mortality (p>0.05).
CONCLUSION
Advanced age, male gender, a high ASA score, a dependent preoperative ADL score, and a postoperative inability to walk were determined to be the most important risk factors affecting mortality in elderly patients with hip fracture. The mortality risk was 11.7 times greater than that of a population with similar characteristics.
LEVEL OF EVIDENCE
Level IV, Therapeutic study.
目的
本研究旨在分析接受髋关节置换术治疗髋部骨折的老年患者的死亡率与可能的风险因素之间的关系，并确定特定队列中的死亡率和年度生存结果。
方法
共有92例接受髋部骨折半髋关节置换术的患者（51例男性（55.4%）和41例女性（44.6%）；平均年龄：76.47岁）纳入本研究。记录了这92例患者与风险因素相关的以下数据：年龄、性别、骨折前日常生活活动能力（ADL）、骨折类型、美国麻醉医师协会（ASA）评分、治疗方法、麻醉类型、骨折至手术的时间长度、术后活动能力和住院时间。采用多因素逻辑回归检验评估风险因素与第一年和第二年死亡率之间的相关性。分析了术后第三年的死亡率，并与居住在同一城市的同一年龄组类似人群的总体死亡率进行了比较。
结果
第一年随访后的死亡率为18.5%（17例患者），第二年为25%（23例患者）。发现髋部骨折后的死亡风险在第三年比同年龄组的类似人群高11.7倍。此外，术前ADL评分低（依赖）、高龄（>80岁）、男性、ASA评分高和行走能力差（无法行走）与第一年和第二年死亡率之间存在显著关系（p<0.05）。然而，未发现骨折类型、骨折侧、麻醉类型、骨折至手术时间或住院时间与死亡率之间存在显著关系（p>0.05）。
结论
高龄、男性、ASA评分高、术前ADL评分依赖和术后无法行走被确定为影响老年髋部骨折患者死亡率的最重要风险因素。死亡风险比具有相似特征的人群高11.7倍。
证据水平
IV级，治疗性研究。
Zotero 插件