低体重指数与骨盆和髋臼骨折患者的死亡率增加有关。

Low body mass index is associated with increased mortality in patients with pelvic and acetabular fractures.

机构信息

Cambridge Orthopaedic Pelvic Unit (COPU), Addenbrooke's Hospital Major Trauma Centre, Cambridge University Hospitals NHS Foundation Trust, United Kingdom.

出版信息

Injury. 2021 Aug;52(8):2322-2326. doi: 10.1016/j.injury.2021.04.066. Epub 2021 May 4.

DOI:10.1016/j.injury.2021.04.066

PMID:34083023

Abstract

AIMS

Fractures of the pelvis and acetabulum are often the consequence of high energy trauma in young individuals or fragility fractures in osteoporotic bone. They can be life-threatening or life changing injuries. No published data exists comparing body mass index (BMI) and mortality for this patient group. The aim of this study was to identify if low BMI (<18.5) was a predictor of morbidity and mortality for patients with these injuries.

PATIENTS AND METHODS

Of the 1033 patients with pelvic or acetabular fractures referred to a single level 1 major trauma centre (MTC) over a 4.5-year period (August 2015 - January 2020); we retrospectively analysed data for all admitted patients. Data was collected on demographics, injury pattern, operative intervention and complications. Comparison was made between patients that were underweight (BMI<18.5) and patients that were not. Both in-hospital and post discharge complications were recorded including pulmonary embolus (PE), deep venous thrombosis (DVT), ileus, infection, loss of reduction and mortality at 6 months.

RESULTS

569 patients admitted to the MTC with a pelvic or acetabular fracture were included in our analysis. Underweight patients had a statistically significant increase in mortality both in-hospital (p = 0.019) and at 6 months post injury (p = 0.039) when compared to other BMI groups. No statistical significance was found between these BMI groups comparing morbidity: DVT (p = 0.712), PE (p = 0.736) nor ileus (p = 0.149). Covariate analysis showed that a low BMI was associated with triple the in-hospital mortality after correction for age and energy of injury (adjusted OR 3.028, 95% CI 1.059-8.659).

CONCLUSION

This is the first published study that demonstrates a statistically significant increase in mortality in patients with pelvic or acetabular fractures who are underweight. Surgeons should carefully consider appropriate peri-operative optimisation for these patients. Further investigation into the effects of low BMI and response to trauma is required.

摘要

目的

骨盆和髋臼骨折通常是年轻人高能创伤或骨质疏松性骨折的后果。它们可能危及生命或改变生活。目前尚无比较此类患者群体的体质指数（BMI）和死亡率的发表数据。本研究的目的是确定低 BMI（<18.5）是否是这些损伤患者发病率和死亡率的预测因素。

患者和方法

在 4.5 年期间（2015 年 8 月至 2020 年 1 月），将 1033 名骨盆或髋臼骨折患者转诊至一家单一的 1 级主要创伤中心（MTC），我们对所有入院患者进行了回顾性数据分析。收集人口统计学、损伤模式、手术干预和并发症的数据。比较体重不足（BMI<18.5）患者和体重正常患者。记录院内和出院后并发症，包括肺栓塞（PE）、深静脉血栓形成（DVT）、肠梗阻、感染、复位丢失和 6 个月时的死亡率。

结果

在我们的分析中，有 569 名 MTC 收治的骨盆或髋臼骨折患者纳入研究。与其他 BMI 组相比，体重不足的患者在院内（p=0.019）和受伤后 6 个月（p=0.039）的死亡率均有统计学意义增加。在这些 BMI 组之间，比较发病率：DVT（p=0.712）、PE（p=0.736）和肠梗阻（p=0.149），无统计学意义。协变量分析表明，在纠正年龄和损伤能量后，低 BMI 与院内死亡率增加三倍相关（调整后的 OR 3.028，95%CI 1.059-8.659）。