General Intensive Care Unit, Soroka University Medical Center, Beer-Sheva, Israel,
Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel,
Gerontology. 2021;67(3):299-305. doi: 10.1159/000513450. Epub 2021 Feb 17.
One-year mortality following hip fractures increases steeply with age, from 2% in the 60- to 69-year-old population up to 28% in the oldest old (older than 90 years). Of the various factors that contribute to hip fractures, atrial fibrillation (AF) is an independent risk factor at any age.
The objective of this study was to assess the association of AF with mortality among the oldest old with hip fractures.
This is a retrospective cohort study of 701 persons above age 90 years who underwent orthopedic repair for a hip fracture during 2000-2018. Of them, 218 (31%) had AF at hospital admission. The primary outcome was survival following surgery. We compared patient characteristics and 30-day, 180-day, 1-year, and 3-year survival between patients with and without AF.
The adjusted odds ratio for 30-day postoperative mortality for those with AF versus without AF group was 1.03 (95% confidence interval [CI] 0.63-1.66). Survival estimates were higher among those without AF than with AF at 180 days postoperative: 0.85 (95% CI 0.82-0.89) versus 0.68 (95% CI 0.61-0.74), p < 0.001; at 1 year postoperative: 0.68 (95% CI 0.63-0.72) versus 0.48 (95% CI 0.42-0.55), p < 0.001; and at 3 years postoperative: 0.47 (95% CI 0.42-0.52) versus 0.28 (95% CI 0.27-0.34), p < 0.001.
Among individuals aged >90 years, operated for hip fractures, mortality was similar for those with and without AF at 30 days postoperative. However, the survival curves diverged sharply after 180 days. Our findings suggest that AF is not an immediate surgical risk factor, but rather confers increased long-term risk in this population.
髋部骨折后一年的死亡率随年龄急剧上升，从 60-69 岁人群的 2%上升到 90 岁以上人群的 28%。在导致髋部骨折的各种因素中，心房颤动（AF）是任何年龄段的独立危险因素。
本研究旨在评估 AF 与髋部骨折的最老年患者死亡率之间的关系。
这是一项回顾性队列研究，纳入了 701 名年龄在 90 岁以上的患者，他们在 2000 年至 2018 年期间接受了骨科修复手术治疗髋部骨折。其中 218 名（31%）入院时患有 AF。主要结局是手术后的生存情况。我们比较了有和无 AF 患者的特征以及 30 天、180 天、1 年和 3 年的生存率。
与无 AF 组相比，AF 患者术后 30 天的死亡调整比值比为 1.03（95%置信区间 [CI] 0.63-1.66）。无 AF 患者的术后 180 天生存率高于有 AF 患者：0.85（95%CI 0.82-0.89）vs. 0.68（95%CI 0.61-0.74），p < 0.001；术后 1 年生存率：0.68（95%CI 0.63-0.72）vs. 0.48（95%CI 0.42-0.55），p < 0.001；术后 3 年生存率：0.47（95%CI 0.42-0.52）vs. 0.28（95%CI 0.27-0.34），p < 0.001。
在 90 岁以上接受髋部骨折手术的患者中，AF 患者和无 AF 患者术后 30 天的死亡率相似。然而，180 天后的生存曲线明显分化。我们的发现表明，AF 不是一个即时的手术危险因素，而是在该人群中增加了长期风险。
