Orthopaedic Department, University of Chile Clinical Hospital, Santiago, Chile.
Epidemiology Department, University of Chile, Santiago, Chile.
Hip Int. 2020 Sep;30(1_suppl):54-58. doi: 10.1177/1120700020938029.
To estimate survival curves in patients with hip fracture according to gender, age, type of fracture, and waiting time for surgery and to compare them with the life expectancy of the general population. The study hypothesis is that survival after hip fractures is significantly lower than in the general population, especially in cases that underwent delayed surgery, regardless of age and gender.
A survival analysis study was designed and approved by our institutional ethics review board. All patients who were coded with a diagnosis of hip fracture from 2002 to 2018 were included in the study. A total of 1176 patients were included, and the median age was 81 years (18-105 years). Kaplan-Meier curves and log-rank tests were performed to compare survival curves between those who underwent surgery on time and those with surgical delays. An exponential multivariate regression model was estimated, and a hazard ratio (HR) was reported for age, gender, and wait time for surgery. A significance of 5% was used, and a confidence interval level of 95% was reported.
The Kaplan-Meier curves for delayed surgery (log-rank, = 0.00) and the age group (log-rank, = 0.00) were significantly different. Exponential regression estimated an HR 1.05 (1.05-1.07) for age, HR 1.80 (1.51-2.13) for men, and HR 1.93 (1.61-2.31) for each day of wait for surgery.
The 2 significant findings of this study are that hip fracture patients over 40 years old have a higher risk of dying at any time compared to the general population and that the waiting time for surgery (a modifiable factor) decreases survival rates at any time.
根据性别、年龄、骨折类型和手术等待时间估计髋部骨折患者的生存曲线，并将其与普通人群的预期寿命进行比较。研究假设是髋部骨折后的生存率明显低于普通人群，尤其是在接受延迟手术的情况下，无论年龄和性别如何。
本研究设计并经机构伦理审查委员会批准。所有 2002 年至 2018 年编码为髋部骨折的患者均纳入研究。共纳入 1176 例患者，中位年龄为 81 岁（18-105 岁）。进行 Kaplan-Meier 曲线和对数秩检验，比较按时手术和手术延迟患者的生存曲线。估计指数多变量回归模型，并报告年龄、性别和手术等待时间的风险比（HR）。使用 5%的显著性水平，并报告 95%置信区间水平。
延迟手术（对数秩检验，P=0.00）和年龄组（对数秩检验，P=0.00）的 Kaplan-Meier 曲线差异有统计学意义。指数回归估计年龄的 HR 为 1.05（1.05-1.07），男性为 HR 1.80（1.51-2.13），手术等待时间每增加一天 HR 为 1.93（1.61-2.31）。
本研究有 2 个重要发现，一是 40 岁以上髋部骨折患者在任何时候死亡的风险均高于普通人群，二是手术等待时间（可改变因素）降低了任何时候的生存率。
