Department of Orthopaedics, Copenhagen University Hospital Herlev-Gentofte, Hellerup 2900, Denmark.
Department of Cardiology, Research 1, Copenhagen University Hospital Herlev-Gentofte, Hellerup 2900, Denmark.
Age Ageing. 2021 Jun 28;50(4):1252-1260. doi: 10.1093/ageing/afaa279.
Hip fractures lead to a substantial burden of disease and mortality among the elderly. Myocardial infarction (MI) and stroke are serious and overlooked complications, and their impact on mortality and morbidity may be underestimated. We investigated; 90-day absolute risk of stroke and MI following hip fracture surgery, and ii) anamnestic risk factors associated with elevated risk of postoperative MI and stroke.
All Danish patients aged ≥60 undergoing first time hip fracture surgery in 2000-2017 were identified. Outcomes were MI or stroke 90 days after surgery. We performed gender-stratified cumulative incidence functions and multivariate Cox regression models adjusted for age and comorbidities.
124,660 patients were included. Incidence of MI was 2.2% and 1.3%, and incidence of stroke was 3.5% and 2.5%, in men and women, respectively. The most important risk factor for MI and stroke was a previous event. Hazard ratio (HR) of MI associated with previous MI was 2.43 (95% Confidence Interval (CI) 2.02-2.92) in men and 2.65 (95% CI 2.23-3.16) in women, while the HR of stroke associated with previous stroke was 4.17 (95% CI 3.73-4.67) and 3.73 (95% CI 3.43-4.08), respectively. Other risk factors of MI were; sex, age, and a history of heart failure, hypertension, peripheral artery disease or diabetes. For postoperative stroke; sex age, and atrial fibrillation were important risk factors.
MI and stroke after hip fractures are overlooked and serious complications. Persons with elevated risk can be identified at admission, based on their medical history.
髋部骨折会给老年人带来严重的疾病负担和死亡率。心肌梗死（MI）和中风是严重且被忽视的并发症，其对死亡率和发病率的影响可能被低估。我们调查了：①髋部骨折手术后 90 天内中风和 MI 的绝对风险；②与术后 MI 和中风风险升高相关的病史危险因素。
确定 2000 年至 2017 年间首次接受髋部骨折手术的所有丹麦≥60 岁的患者。术后 90 天的结局为 MI 或中风。我们进行了性别分层的累积发病率函数和多变量 Cox 回归模型，调整了年龄和合并症。
共纳入 124660 例患者。男性和女性的 MI 发生率分别为 2.2%和 1.3%，中风发生率分别为 3.5%和 2.5%。MI 和中风的最重要危险因素是既往事件。与既往 MI 相关的 MI 风险比（HR）在男性为 2.43（95%置信区间（CI）2.02-2.92），在女性为 2.65（95% CI 2.23-3.16），而与既往中风相关的中风风险比（HR）分别为 4.17（95% CI 3.73-4.67）和 3.73（95% CI 3.43-4.08）。MI 的其他危险因素还包括性别、年龄以及心力衰竭、高血压、外周动脉疾病或糖尿病的病史。对于术后中风，性别、年龄和心房颤动是重要的危险因素。
髋部骨折后 MI 和中风是被忽视的严重并发症。可以根据患者的病史，在入院时识别出风险较高的患者。
