Vigni Giulio Edoardo, Bosco Francesco, Cioffi Alessio, Camarda Lawrence
Department of Orthopaedics and Traumatology (DiChirOnS), University of Palermo, Palermo, Italy.
Geriatr Orthop Surg Rehabil. 2021 Feb 9;12:2151459321991503. doi: 10.1177/2151459321991503. eCollection 2021.
In patients over 65y.o. who were surgically treated for a hip fracture, electrolytes have not been specifically studied as predictors of mortality. The main purpose of this study was to assess whether electrolytes and chronic kidney disease (CKD) stages, evaluated at admission, could represent a pre-operative prognostic factor in this population. Moreover, the role of epidemiological and clinical parameters was analyzed with and without a surgical timing stratification. This retrospective study included 746 patients. For each patient, their age, gender, fracture classification, Hb value, comorbidities, ASA class, chronic kidney disease, creatinine levels, electrolytes and surgical timing were collected. CKD-epi, MDRD, modified MDRD and BIS1 were used to obtain eGFR and CKD stages. All parameters were analyzed individually and in relation to the different surgical timing. Descriptive statistics, Chi-square test and survivability analysis with Kaplan Meier curve were used. In patients with a hip fracture non-significant association with increased mortality was shown for the following variables: Hb value, sodium values, calcium values, CKD stages and creatinine values. Otherwise altered kalemia was associated with a statistically significant increase in mortality as well as male gender, two or more comorbid medical conditions, advanced age (>75 years), higher ASA class. Surgery performed within 72h resulted in a statistically significant reduction in mortality at 6 months and, when performed in 24h-48h, a further reduction at 4 years. Age and ASA class statistically significant increased mortality regardless the surgical timing. Male patients operated after 48h from hospitalization were associated with a statistically significant increase in mortality rate. Two or more comorbidities were related to a statistically significant increased number of deaths when patients were treated after 96h. Altered kalemia values at hospitalization are associated with a statistically significant increase in mortality in patients operated after 72h from admission.
在接受手术治疗髋部骨折的65岁以上患者中，尚未对电解质作为死亡率预测指标进行专门研究。本研究的主要目的是评估入院时评估的电解质和慢性肾脏病（CKD）分期是否可作为该人群术前的预后因素。此外，还分析了有无手术时机分层情况下流行病学和临床参数的作用。这项回顾性研究纳入了746例患者。收集了每位患者的年龄、性别、骨折分类、血红蛋白值、合并症、美国麻醉医师协会（ASA）分级、慢性肾脏病、肌酐水平、电解质和手术时机。采用慢性肾脏病流行病学协作组（CKD-epi）公式、肾脏病饮食改良试验（MDRD）公式、改良MDRD公式和BIS1公式来计算估算肾小球滤过率（eGFR）和CKD分期。对所有参数进行了单独分析，并分析了其与不同手术时机的关系。采用描述性统计、卡方检验以及Kaplan-Meier曲线生存分析。在髋部骨折患者中，以下变量与死亡率增加无显著关联：血红蛋白值、钠值、钙值、CKD分期和肌酐值。否则，血钾异常与死亡率的统计学显著增加相关，同样相关的还有男性性别、两种或更多种合并内科疾病、高龄（>75岁）、较高的ASA分级。在72小时内进行手术导致6个月时死亡率有统计学显著降低，而在24小时至48小时内进行手术时，4年时死亡率进一步降低。无论手术时机如何，年龄和ASA分级在统计学上均显著增加死亡率。住院后48小时后接受手术的男性患者死亡率有统计学显著增加。当患者在96小时后接受治疗时，两种或更多种合并症与死亡人数的统计学显著增加相关。入院后72小时后接受手术的患者中，住院时血钾异常值与死亡率的统计学显著增加相关。
