老年踝关节骨折手术治疗的死亡率和发病率。
Mortality and Morbidity of Surgical Management of Geriatric Ankle Fractures.
机构信息
From the Department of Orthopaedics, Warren Alpert Medical School, Brown University, Providence, RI.
出版信息
J Am Acad Orthop Surg. 2020 Aug 15;28(16):678-683. doi: 10.5435/JAAOS-D-19-00048.
INTRODUCTION
The incidence of geriatric ankle fractures is rising. With the substantial variation in the physiologic and functional status within this age group, our null hypothesis was that mortality and complications of open reduction and internal fixation (ORIF) between patients who are aged 65 to 79 are equivalent to ORIF in patients who are aged 80 to 89.
METHODS
Patients with ankle fracture were identified using the International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes. Patients treated with ORIF were identified using the Current Procedural Terminology codes. Patients were divided into two age cohorts: 65 to 79 years of age and 80 to 89 years of age. The primary outcome studied was 30-day mortality. Secondary outcomes included 30-day readmission, revision surgery, surgical site infection, sepsis, wound dehiscence, pulmonary embolism, deep vein thrombosis, blood transfusion, urinary tract infection, pneumonia, stroke, myocardial infarction, renal insufficiency or failure, and length of hospital stay.
RESULTS
Our cohort included 2,353 ankle fractures: 1,877 were among 65 to 79 years of age and 476 were among 80 or older. Thirty-day mortality was 3.2-fold higher in the 80 to 89 years of age group compared with the 65 to 79 years of age group (1.47% versus 0.48%, P = 0.019). However, after controlling for the ASA class, 80 to 89 years of age patients no longer had a significantly higher mortality (P = 0.0647). Similarly, revision surgery rate (3.36% versus 1.81%, P = 0.036), transfusion requirement (2.94% versus 1.49%, P = 0.033), urinary tract infection (1.89% versus 0.75%, P = 0.023), and hospital length of stay (4.9 versus 2.9 days, P < 0.0001) were all significantly higher in the 80 to 90 years of age group compared with the 65 to 79 years old group. However, after controlling for the ASA class, 80 to 89 years old patients no longer had a rate of complications in comparison to the 65 to 79 years old age group.
DISCUSSION
After controlling for comorbidities (ie, the ASA class), no increased risk is observed for the 30-day mortality or complication rate between geriatric ankle fracture in the 65 to 79 years old and the 80 to 99 years old age groups.
LEVEL OF EVIDENCE
Prognostic level III, retrospective study.
简介
老年踝关节骨折的发病率正在上升。由于该年龄段患者的生理和功能状态存在很大差异，我们的零假设是，65 至 79 岁患者行切开复位内固定术（ORIF）的死亡率和并发症与 80 至 89 岁患者行 ORIF 的死亡率和并发症相当。
方法
使用国际疾病分类，第九修订版，临床修正诊断代码识别踝关节骨折患者。使用当前操作术语代码识别接受 ORIF 治疗的患者。患者分为两个年龄组：65 至 79 岁和 80 至 89 岁。主要研究结果为 30 天死亡率。次要结果包括 30 天再入院、翻修手术、手术部位感染、败血症、伤口裂开、肺栓塞、深静脉血栓形成、输血、尿路感染、肺炎、中风、心肌梗死、肾功能不全或衰竭以及住院时间。
结果
我们的队列包括 2353 例踝关节骨折：1877 例发生在 65 至 79 岁，476 例发生在 80 岁或以上。80 至 89 岁年龄组的 30 天死亡率是 65 至 79 岁年龄组的 3.2 倍（1.47%比 0.48%，P=0.019）。然而，在控制 ASA 分级后，80 至 89 岁患者的死亡率不再显著更高（P=0.0647）。同样，翻修手术率（3.36%比 1.81%，P=0.036）、输血需求（2.94%比 1.49%，P=0.033）、尿路感染（1.89%比 0.75%，P=0.023）和住院时间（4.9 比 2.9 天，P<0.0001）在 80 至 90 岁年龄组均显著高于 65 至 79 岁年龄组。然而，在控制 ASA 分级后，80 至 89 岁患者的并发症发生率与 65 至 79 岁年龄组相比不再更高。
讨论
在控制合并症（即 ASA 分级）后，65 至 79 岁和 80 至 99 岁老年踝关节骨折患者的 30 天死亡率或并发症发生率无显著增加。
证据等级
预后 III 级，回顾性研究。
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