髋部骨折患者的虚弱、术后谵妄和出院时的功能状态。
Frailty, post-operative delirium and functional status at discharge in patients with hip fracture.
机构信息
School of Medicine and Surgery, Milano-Bicocca University, Monza, Italy.
Department of Statistics and Quantitative Methods, Unit of Biostatistics, Epidemiology and Public Health, University of Milano- Bicocca, Milan, Italy.
出版信息
Int J Geriatr Psychiatry. 2021 Oct;36(10):1524-1530. doi: 10.1002/gps.5561. Epub 2021 May 1.
OBJECTIVE
To explore the effect of frailty, alone and in combination with post-operative delirium (POD), on the risk of poor function at discharge in patients with hip fracture (HF).
METHODS
This is a prospective cohort study of patients with HF admitted to an Orthogeriatric Unit (OGU) between October 1, 2011 and March 15, 2019. POD was assessed using the 4AT and the Diagnostic and Statistical Manual of Mental Disorders (DSM) 5-edition criteria. A 22-items Frailty Index (FI) was created using the data collected on admission. The outcome measure was the Cumulated Ambulation Score (CAS) score at discharge. A log-binomial regression model was used to assess the effect of frailty and POD on CAS.
RESULTS
A total of 988 patients (median age = 84.9 years, Interquartile range = 80.6-89.2) were included: 360 patients (36.4%) were frail and 411 (42%) developed POD. Poor functional status at discharge (CAS score ≤2) was more common in frail than non-frail patients (68.3% vs. 53.8%, p < 0.001) In a regression adjusted for confounders, frailty alone (Relative Risk, RR = 1.33, 95% Confidence Intervals, CI = 1.14-1.55) and POD alone (RR 1.38, 95% CI = 1.2-1.59) were associated with poor functional status at discharge; when combined, frailty and POD had an interaction, yielding a mild increase in the risk of poor outcome (RR 1.47, 95% CI = 1.28-1.69).
CONCLUSIONS
In older patients undergoing HF surgery, frailty, POD and their combination, are associated with poor functional status at discharge.
目的
探讨衰弱（alone）及衰弱合并术后谵妄（post-operative delirium，POD）对髋部骨折（hip fracture，HF）患者出院时功能不良风险的影响。
方法
这是一项前瞻性队列研究，纳入 2011 年 10 月 1 日至 2019 年 3 月 15 日期间入住骨科老年病房（Orthogeriatric Unit，OGU）的 HF 患者。采用 4AT 量表和精神障碍诊断与统计手册（Diagnostic and Statistical Manual of Mental Disorders，DSM）第 5 版标准评估 POD。入院时收集的数据用于创建 22 项衰弱指数（Frailty Index，FI）。出院时的结局指标为累积活动评分（Cumulated Ambulation Score，CAS）。采用对数二项回归模型评估衰弱和 POD 对 CAS 的影响。
结果
共纳入 988 例患者（中位年龄 84.9 岁，四分位距 80.6-89.2）：360 例（36.4%）衰弱，411 例（42%）发生 POD。衰弱患者出院时功能不良（CAS 评分≤2）的比例高于非衰弱患者（68.3% vs. 53.8%，p<0.001）。在校正混杂因素后，衰弱本身（相对风险，RR 1.33，95%置信区间，CI 1.14-1.55）和 POD 本身（RR 1.38，95% CI 1.2-1.59）与出院时的功能不良相关；当两者合并时，衰弱和 POD 存在交互作用，使不良结局的风险轻度增加（RR 1.47，95% CI 1.28-1.69）。
结论
在接受 HF 手术的老年患者中，衰弱、POD 及其合并症与出院时的功能不良状态相关。
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