Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan.
Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
Geriatr Gerontol Int. 2021 May;21(5):398-403. doi: 10.1111/ggi.14153. Epub 2021 Mar 25.
Among older patients undergoing hip fracture surgery, previous studies have shown a seasonal variation of in-hospital surgical complications. However, little is known about seasonal effects on mortality and systemic complications after hip fracture surgery. In the present study, we evaluated whether mortality and in-hospital systemic complications are influenced by seasonal differences.
We enrolled patients from a nationwide database who underwent hip fracture surgery between 2010 and 2018. The primary outcome was in-hospital mortality. The secondary outcomes were in-hospital systemic complications. The association between the seasonality and in-hospital outcomes was investigated using multivariable Cox, logistic regression and causal mediation analysis.
With 425 856 patients (mean age 83.5 years; 79% women), overall in-hospital mortality was 5324 (1.2%). Fall and winter were associated with a higher mortality than spring (hazard ratio [HR] 1.16; P < 0.001; HR 1.14; P = 0.001, respectively). Across all the seasons, there were 36 834 overall systemic complications (8.6%), with respiratory infection being the most frequent (18 637 [4.4%]). Among these complications, only respiratory infection showed seasonal variation, with a higher prevalence in fall and winter. The mediated effect of respiratory infection on mortality was significantly higher in fall and winter compared with spring (fall, HR 1.06, proportion mediated 36.7%; winter, HR 1.14, proportion mediated 55.0%; all P < 0.001).
We found a significantly higher mortality in fall and winter after hip fracture surgery. Specifically, in winter, the increased in-hospital death was largely attributed to the increased incidence of respiratory infection. Geriatr Gerontol Int 2021; 21: 398-403.
在接受髋部骨折手术的老年患者中，先前的研究表明住院手术并发症存在季节性变化。然而，髋部骨折手术后，关于季节性对死亡率和全身并发症的影响知之甚少。在本研究中，我们评估了死亡率和住院期间全身并发症是否受季节性差异的影响。
我们纳入了 2010 年至 2018 年期间在全国数据库中接受髋部骨折手术的患者。主要结局是住院期间的死亡率。次要结局是住院期间的全身并发症。使用多变量 Cox、逻辑回归和因果中介分析来研究季节性与住院结局之间的关系。
共纳入 425856 例患者（平均年龄 83.5 岁，79%为女性），共有 5324 例（1.2%）患者在院死亡。与春季相比，秋季和冬季的死亡率更高（风险比 [HR] 1.16；P<0.001；HR 1.14；P=0.001）。在所有季节中，共有 36834 例（8.6%）患者发生全身并发症，其中最常见的是呼吸道感染（18637 例[4.4%]）。在这些并发症中，只有呼吸道感染存在季节性变化，秋季和冬季的发生率更高。与春季相比，秋季和冬季呼吸道感染对死亡率的中介效应显著更高（秋季，HR 1.06，中介效应比例为 36.7%；冬季，HR 1.14，中介效应比例为 55.0%；均 P<0.001）。
我们发现髋部骨折手术后秋季和冬季的死亡率显著更高。具体来说，在冬季，住院死亡增加主要归因于呼吸道感染发生率的增加。
