Department of Nursing, Faculty of Allied Health Sciences, University of Ruhuna, Galle, Sri Lanka.
Department of Medicine, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.
Arch Osteoporos. 2020 Jun 25;15(1):95. doi: 10.1007/s11657-020-00769-6.
One hundred and eighty patients with incident fragility hip fracture admitted to a tertiary care center in Sri Lanka were followed up for 12 months. When compared with those survived, patients who died were older and had higher comorbidity and physical impairment, before fracture and at discharge from the hospital.
This study examined the factors that are associated with mortality within the first 12 months, of patients admitted with fragility hip fracture to a tertiary care center in Southern Sri Lanka.
One hundred and eighty consecutive patients admitted with new fragility hip fracture were followed up for 12 months post-fracture. Apart from age and gender, information related to physical dependency (prefracture and at discharge) and comorbidity were collected from all subjects.
Of 180 patients (149women), 107 had surgery while the rest were managed conservatively. Mean (SD) age of study subjects was 76.5 (9.2 years). Thirty-three patients died within the first 12 months were older and had higher comorbidity and physical impairment before fracture and at discharge from the hospital, when compared with those survived. Relative risk (95% CI, p value) of death for being a male was 6.52 (3.18-11.5, < 0.001) and corresponding values for conservative management were 6.59 (2.86-15.2, < 0.001). In the ROC analysis, in which mortality/survival was taken as state variable, AUCs for age, Charlson index, age-adjusted Charlson index, and Barthel index before fracture and Barthel index at discharge were 0.77 (0.04), 0.79 (0.04), 0.70 (0.05), 0.67 (0.05), and 0.76 (0.04 ) (p < 0.01 for all). Age-adjusted odd ratios (95% CI) of ACCI, CCI, surgical management, and Barthel index before fracture and at discharge were 2.21 (1.37 to 3.57), 2.37 (1.46 to 3.83), 0.18 (0.06 to 0.53), 0.91 (0.85 to 0.97), and 0.93 (0.88 to 0.99), respectively (p < 0.05 for all).
We conclude that advanced age, male gender, higher comorbidity, physical impairment before and after fracture, and conservative management lead to a higher risk of mortality in patients admitted with incident fragility hip fracture. This study can be used as a platform for future research in this area in Sri Lanka.
本研究旨在探讨斯里兰卡一家三级护理中心收治的脆性髋部骨折患者在骨折后 12 个月内死亡的相关因素。
连续纳入 180 例新发脆性髋部骨折患者，在骨折后 12 个月进行随访。除年龄和性别外，所有患者还收集了与身体依赖（骨折前和出院时）和合并症相关的信息。
180 例患者（149 例女性）中 107 例行手术治疗，其余患者接受保守治疗。研究对象的平均（SD）年龄为 76.5（9.2）岁。33 例患者在 12 个月内死亡，与存活患者相比，这些患者年龄更大，骨折前和出院时合并症和身体功能障碍更严重。与男性相比，男性死亡的相对风险（95%CI，p 值）为 6.52（3.18-11.5，<0.001），保守治疗的相应值为 6.59（2.86-15.2，<0.001）。在以死亡/存活为状态变量的 ROC 分析中，骨折前和出院时年龄、Charlson 指数、年龄调整Charlson 指数和 Barthel 指数的 AUC 分别为 0.77（0.04）、0.79（0.04）、0.70（0.05）、0.67（0.05）和 0.76（0.04）（均<0.01）。骨折前和出院时的年龄调整优势比（95%CI）为 ACCI、CCI、手术治疗和 Barthel 指数分别为 2.21（1.37-3.57）、2.37（1.46-3.83）、0.18（0.06-0.53）、0.91（0.85-0.97）和 0.93（0.88-0.99）（均<0.05）。
我们得出结论，年龄较大、男性、较高的合并症、骨折前后的身体功能障碍以及保守治疗会增加脆性髋部骨折患者的死亡风险。本研究可作为斯里兰卡该领域未来研究的平台。
