老年髋部骨折患者应用抗凝药物的影响。我们是否应该采取不同的方法？
Impact of anticoagulants in elderly patients who suffer a hip fracture. Should we have a different approach?
机构信息
Servicio de Ortopedia y Traumatología, Hospital Italiano de Buenos Aires, CABA, Argentina.
Área de investigación en medicina Interna, Servicio de Clínica Médica, Hospital Italiano de Buenos Aires, CABA Argentina.
出版信息
Acta Biomed. 2020 Jul 10;91(4):ahead of print. doi: 10.23750/abm.v91i4.8975.
INTRODUCTION
Hip fracture in the elderly is a frequent problem. Chronic treatment with anticoagulants is common in these patients, and may delay surgery.
OBJECTIVES
To compare time to surgery, hospital stay, in-hospital and 90 days complications between anticoagulated (A) and non-anticoagulated (NA) groups.
METHODS
Retrospective cohort of >64 years-old patients with acute hip fracture. Period June-2014 to December 2019. We estimated crude and adjusted OR (95%CI) for in-hospital complications with logistic regression model. We report the crude and adjusted HR for readmission and 90-day mortality with Cox proportional hazards model.
RESULTS
Of the 1058 patients, 123 (11%) were anticoagulated. Time to surgery was 26.4 hours (IIQ 13.9-48) in A and 24 hours (IIQ 2.3-48) in NA, p0.001. Hospital stay was 7 days (IIQ 5-9) in A and 6 days (IIQ 5-10.5) NA, p0,000. In-hospital complications were 17 (14%) in A and 81 (9%) in NA, p0.064. The adjusted OR was 1.53 (95%CI 0.8-2.7) p0.138. For 90-day readmission, the crude HR was 1.51 (95%CI 0.99-2.29) p0.053 and the adjusted HR was 1.31 (95%CI 0.85-2.00) p0,09. For 90-day mortality, the crude HR was 0.80 (95%CI 0.45-1.43) p0.464 and the adjusted HR was 0.70 (95% CI 0.39-1.25) p0.239.
DISCUSSION
While we found differences between groups in time to surgery and hospital statistics, their clinical relevance should be reviewed.
引言
老年人髋部骨折是一个常见问题。这些患者常需长期接受抗凝治疗，这可能会延迟手术。
目的
比较抗凝（A）和非抗凝（NA）组患者的手术时间、住院时间、住院期间和 90 天内并发症。
方法
回顾性分析 2014 年 6 月至 2019 年 12 月间 64 岁以上急性髋部骨折患者。使用逻辑回归模型估计住院期间并发症的粗比值比（OR）（95%CI），使用 Cox 比例风险模型报告再入院和 90 天死亡率的粗和调整后的 HR。
结果
1058 例患者中，123 例（11%）接受抗凝治疗。A 组手术时间为 26.4 小时（IQR13.9-48），NA 组为 24 小时（IQR2.3-48），p0.001。A 组住院时间为 7 天（IQR5-9），NA 组为 6 天（IQR5-10.5），p0.000。A 组住院期间并发症为 17 例（14%），NA 组为 81 例（9%），p0.064。调整后的 OR 为 1.53（95%CI0.8-2.7），p0.138。90 天再入院率，粗 HR 为 1.51（95%CI0.99-2.29），p0.053，调整后的 HR 为 1.31（95%CI0.85-2.00），p0.09。90 天死亡率，粗 HR 为 0.80（95%CI0.45-1.43），p0.464，调整后的 HR 为 0.70（95%CI0.39-1.25），p0.239。
讨论
尽管我们发现手术时间和住院统计数据在两组之间存在差异，但应重新评估其临床相关性。
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