Research Unit for General Practice, Department of Public Heath, University of Southern Denmark, Odense, Denmark.
Department of Mental Health Vejle, Mental Health Services in the Region of Southern Denmark, Vejle, Denmark.
Brain Behav. 2020 Nov;10(11):e01823. doi: 10.1002/brb3.1823. Epub 2020 Sep 6.
Patients with dementia have an increased 30-day mortality after hip fracture. We investigated clinical management including time to surgery, out-of-hours admission and surgery, surgery on weekends, surgery volume per ward, and anesthesia technique for this excess mortality risk.
This register- and population-based study comprised 12,309 older adults (age 70+) admitted to hospital for a first-time hip fracture in 2013-2014, of whom 11,318 underwent hip fracture surgery. Cox proportional hazards regression models were applied for the analysis.
The overall postoperative 30-day mortality was 11.4%. Patients with dementia had a 1.5 times increased mortality risk than those without (HR = 1.50 [95% CI 1.31-1.72]). We observed no time-to-surgery difference by patient dementia status; additionally, the excess mortality risk in patients with dementia could not be explained by the clinical management factors we examined.
Increased mortality in patients with dementia could not be explained by the measured preoperative clinical management. Suboptimal handling of postoperative complication and rehabilitation are to be investigated for their role in the witnessed increased mortality for patients with dementia.
痴呆症患者髋部骨折后 30 天死亡率增加。我们研究了临床管理，包括手术时间、非工作时间入院和手术、周末手术、每个病房的手术量以及麻醉技术，以了解这种额外的死亡风险。
这是一项基于登记和人群的研究，纳入了 2013-2014 年首次因髋部骨折住院的 12309 名 70 岁以上的老年人，其中 11318 人接受了髋部骨折手术。采用 Cox 比例风险回归模型进行分析。
总体术后 30 天死亡率为 11.4%。痴呆症患者的死亡率比无痴呆症患者高 1.5 倍（HR=1.50 [95%CI 1.31-1.72]）。我们没有观察到患者痴呆状态与手术时间之间的差异；此外，我们研究的临床管理因素并不能解释痴呆症患者的额外死亡风险。
术前临床管理不能解释痴呆症患者死亡率的增加。术后并发症和康复处理不当的情况，需要进一步研究其在痴呆症患者中增加死亡率的作用。
