Department of Arthrology, Dongyang People's Hospital, Wenzhou Medical University Affiliated Dongyang Hospital, Dongyang, China.
Orthop Surg. 2021 May;13(3):958-965. doi: 10.1111/os.12983. Epub 2021 Apr 4.
To investigate the risk factors for, and outcomes of, preoperative asymptomatic pulmonary embolism (PE) in patients ≥60 years old following delayed operation for hip fracture.
From March 2017 to December 2018, 90 patients aged ≥60 years with hip fracture who suffered a delay in surgery were recruited to this prospective study following admission to our hospital. Computed tomography pulmonary angiography (CTPA) was used to detect preoperative asymptomatic PE and calculated its incidence. Time from injury to admission, baseline characteristics, medical comorbidities, and blood biomarker levels were evaluated as potential risk factors. Logistic regression analysis was used to identify risk factors. Mortality and major bleeding events were recorded and compared between individuals with PE and without. Data were analyzed by t-test, Mann-Whitney U test, χ test, Fisher's exact test, and logistic regression analysis.
The incidence of preoperative asymptomatic PE was 18.9% (17/90 patients). In the univariate analysis, the risk factors for preoperative asymptomatic PE were male sex, hypertension, cerebrovascular accident, smoking, plasma D-dimer level, potassium level, urea level, creatinine level, and cysteine level. Multivariate logistic regression analysis showed that the risk of preoperative asymptomatic PE was higher in patients with hypertension (odds ratio [OR] = 10.048; 95% confidence interval [CI], 1.118-90.333), cerebrovascular accident (OR = 20.135; 95% CI, 1.875-216.164), smoking (OR = 48.741; 95% CI, 4.155-571.788), high plasma D-dimer levels (OR = 1.200; 95% CI, 1.062-157.300), and high plasma potassium levels (OR = 12.928; 95% CI, 1.062-157.300). All patients were followed up for 21.0 months (range, 2 to 36 months). Mortality within the first year postoperatively was higher in patients with PE (29.41% vs 9.59%, P = 0.046).
In view of the high incidence of preoperative asymptomatic PE and the inferior prognosis in individuals with PE, routine CTPA examination for preoperative asymptomatic PE could be useful for patients aged ≥60 years with hip fracture for whom surgery is delayed.
探讨≥60 岁髋部骨折延迟手术患者术前无症状肺栓塞（PE）的危险因素及结局。
本前瞻性研究于 2017 年 3 月至 2018 年 12 月连续纳入我院收治的 90 例≥60 岁髋部骨折延迟手术患者，采用计算机断层扫描肺动脉造影（CTPA）检测术前无症状性 PE，并计算其发生率。从受伤到入院的时间、基线特征、合并症和血液生物标志物水平被评估为潜在的危险因素。采用 logistic 回归分析确定危险因素。记录并比较有和无 PE 患者的死亡率和主要出血事件。采用 t 检验、Mann-Whitney U 检验、卡方检验、Fisher 确切概率法和 logistic 回归分析进行数据分析。
术前无症状性 PE 的发生率为 18.9%（90 例患者中有 17 例）。单因素分析显示，术前无症状性 PE 的危险因素为男性、高血压、脑血管意外、吸烟、血浆 D-二聚体水平、钾水平、尿素水平、肌酐水平和半胱氨酸水平。多因素 logistic 回归分析显示，高血压（比值比 [OR] = 10.048；95%置信区间 [CI]，1.118-90.333）、脑血管意外（OR = 20.135；95% CI，1.875-216.164）、吸烟（OR = 48.741；95% CI，4.155-571.788）、高血浆 D-二聚体水平（OR = 1.200；95% CI，1.062-157.300）和高血浆钾水平（OR = 12.928；95% CI，1.062-157.300）的患者术前无症状性 PE 风险更高。所有患者均随访 21.0 个月（范围 2 至 36 个月）。术后 1 年内 PE 患者死亡率更高（29.41%比 9.59%，P = 0.046）。
鉴于术前无症状性 PE 发生率较高，且有 PE 患者预后较差，对于髋部骨折且手术延迟的≥60 岁患者，常规行 CTPA 检查术前无症状性 PE 可能是有益的。
