Singapore General Hospital, Outram Rd, Singapore 169608, Singapore.
Singapore General Hospital, Outram Rd, Singapore 169608, Singapore.
Bone. 2021 Feb;143:115567. doi: 10.1016/j.bone.2020.115567. Epub 2020 Jul 31.
Hip fracture patients have severe deterioration of their quality of life and function after their injury. Markers of malnutrition such as low albumin and low body mass index (BMI) have been shown to increase mortality and complication rates but their effect on recovery of quality of life and function after hip fracture surgery is unclear. The main aim of this paper is to further investigate if low albumin affects recovery after hip fracture surgery, while additionally studying low BMI as a possible risk factor for poor recovery.
Retrospective analysis of 971 patients who underwent surgery for fragility hip fractures between January 2012 and December 2016 was performed. Demographic data, preoperative serum albumin and haemoglobin levels, BMI, Charlson Comorbidity Index (CCI), type of surgery (fixation vs replacement) and site of surgery were obtained. Patients were assessed using the Parker Mobility Scale (PMS), Harris Hip Score(HHS), Medical Outcomes Study 36-item Short-Form Health Survey (SF36) at pre-fracture, 6 weeks and 6 months after surgery. HHS was not available pre-operatively. Patients were grouped according to their albumin levels (low ≤35 g/L or normal) and BMI (underweight <18.5 or normal). Univariate and multivariate analyses were performed to examine the association between albumin and BMI and 6-month scores.
On univariate analysis, patients with low albumin ≤35 g/L had lower baseline PMS and SF36 Physical Functioning (PF) score. On multivariate analysis, preoperative hypoalbuminemia was associated with lower 6-month HHS, PMS and SF36 PF scores even after accounting for baseline scores and other confounders. BMI had no effect on 6-month scores.
Low albumin (≤35 g/L) is prevalent in elderly hip fracture patients and is associated with slower recovery of function and quality of life after surgery. Low albumin can be a useful prognostic tool to identify patients with poor recovery for further intervention or rehabilitation after hip fracture surgery.
髋部骨折患者在受伤后生活质量和功能严重恶化。低白蛋白和低体重指数（BMI）等营养不良标志物已被证明会增加死亡率和并发症发生率，但它们对髋部骨折手术后生活质量和功能恢复的影响尚不清楚。本文的主要目的是进一步研究低白蛋白是否会影响髋部骨折手术后的恢复，同时研究低 BMI 是否是恢复不良的一个可能危险因素。
对 2012 年 1 月至 2016 年 12 月期间接受脆性髋部骨折手术的 971 例患者进行回顾性分析。获取患者的人口统计学数据、术前血清白蛋白和血红蛋白水平、BMI、Charlson 合并症指数（CCI）、手术类型（固定术与置换术）和手术部位。患者在骨折前、手术后 6 周和 6 个月时使用帕克活动能力量表（Parker Mobility Scale，PMS）、髋关节评分（Harris Hip Score，HHS）和健康研究 36 项简明健康调查量表（Medical Outcomes Study 36-item Short-Form Health Survey，SF36）进行评估。HHS 术前不可用。根据白蛋白水平（低 ≤35 g/L 或正常）和 BMI（低体重 <18.5 或正常）将患者分组。进行单变量和多变量分析，以检查白蛋白和 BMI 与 6 个月评分之间的关系。
单变量分析显示，白蛋白水平低 ≤35 g/L 的患者基线 PMS 和 SF36 躯体功能（Physical Functioning，PF）评分较低。多变量分析显示，即使考虑到基线评分和其他混杂因素，术前低白蛋白血症与术后 6 个月 HHS、PMS 和 SF36 PF 评分较低相关。BMI 对 6 个月评分无影响。
低白蛋白（≤35 g/L）在老年髋部骨折患者中较为常见，与手术后功能和生活质量恢复较慢有关。低白蛋白可能是一种有用的预后工具，可识别术后恢复不良的患者，以便进一步干预或康复治疗。
