Di Giovanni Pamela, Di Martino Giuseppe, Zecca Isaia Antonio Luca, Porfilio Italo, Romano Ferdinando, Staniscia Tommaso
Department of Pharmacy, "G. d'Annunzio" University of Chieti-Pescara, Via dei Vestini, 31, 66100, Chieti, Italy.
School of Hygiene and Preventive Medicine, "G. d'Annunzio" University of Chieti-Pescara, Via dei Vestini, 31, 66100, Chieti, CH, Italy.
Eur Geriatr Med. 2019 Feb;10(1):61-66. doi: 10.1007/s41999-018-0146-z. Epub 2018 Dec 5.
Increased life expectancy causes higher prevalence of chronic diseases and greater frailty among older persons. Osteoarthritis and hip fracture are the leading causes of disability among the older persons in high income countries. Recent studies showed that patients undergoing hip fracture surgery have an increased risk of mortality and developing complications. The aim of this study was to compare the occurrence of in-hospital mortality events, complications, and 30-hospital readmissions among patients undergoing hip fracture surgery (HFS) and elective hip replacement (EHR).
The study considered all hospital admissions for HFS and EHR performed from 2006 to 2015 in Abruzzo region, Italy. Data were collected from hospital discharge records. To compare outcomes between HFS and EHR, a propensity score matching procedure was performed. Odds ratios with 95% confidence intervals for primary and secondary outcomes were computed using logistic regression models.
A total of 32,248 patients were selected: 23,075 underwent HFS and 9173 underwent EHR. After matching, 18,078 patients were included in the analyses (9039 patients who underwent HFS and 9039 patients who underwent HER). In the matched population, HFS patients showed an increased risk of in-hospital mortality (OR 2.03; 95% CI 1.58-2.61) and 30-day hospital readmission (OR 1.97; 95% CI 1.85-2.09). A sensitivity analysis performed on patients younger than 65 years of age confirmed these findings.
In a cohort of Italian patients, hip fracture surgery was associated with a higher risk of in-hospital mortality and 30-day readmission when compared to elective hip replacement.
预期寿命的增加导致老年人慢性病患病率上升和身体更加虚弱。骨关节炎和髋部骨折是高收入国家老年人残疾的主要原因。最近的研究表明，接受髋部骨折手术的患者死亡风险和发生并发症的风险增加。本研究的目的是比较接受髋部骨折手术（HFS）和择期髋关节置换术（EHR）的患者住院死亡事件、并发症和30天再入院情况的发生率。
本研究纳入了2006年至2015年在意大利阿布鲁佐地区进行的所有HFS和EHR住院病例。数据从医院出院记录中收集。为了比较HFS和EHR之间的结果，进行了倾向得分匹配程序。使用逻辑回归模型计算主要和次要结果的95%置信区间的比值比。
共选择了32248例患者：23075例接受HFS，9173例接受EHR。匹配后，18078例患者纳入分析（9039例接受HFS的患者和9039例接受EHR的患者）。在匹配人群中，HFS患者的住院死亡风险增加（OR 2.03；95%CI 1.58 - 2.61）和30天再入院风险增加（OR 1.97；95%CI 1.85 - 2.09）。对65岁以下患者进行的敏感性分析证实了这些发现。
在一组意大利患者中，与择期髋关节置换术相比，髋部骨折手术的住院死亡风险和30天再入院风险更高。
