From the Department of Orthopedic Surgery, Orebro University Hospital, Orebro, Sweden.
School of Medical Sciences, Orebro University, Orebro, Sweden.
Anesth Analg. 2021 Nov 1;133(5):1225-1234. doi: 10.1213/ANE.0000000000005659.
The high mortality rates seen within the first postoperative year after hip fracture surgery have remained relatively unchanged in many countries for the past 15 years. Recent investigations have shown an association between beta-blocker (BB) therapy and a reduction in risk-adjusted mortality within the first 90 days after hip fracture surgery. We hypothesized that preoperative, and continuous postoperative, BB therapy may also be associated with a decrease in mortality within the first year after hip fracture surgery.
In this retrospective cohort study, all adults who underwent primary emergency hip fracture surgery in Sweden, between January 1, 2008 and December 31, 2017, were included. Patients with pathological fractures and conservatively managed hip fractures were excluded. Patients who filled a prescription within the year before and after surgery were defined as having ongoing BB therapy. The primary outcome of interest was postoperative mortality within the first year. To reduce the effects of confounding from covariates due to nonrandomization in the current study, the inverse probability of treatment weighting (IPTW) method was used. Subsequently, Cox proportional hazards models were fitted to the weighted cohorts. These analyses were repeated while excluding patients who died within the first 30 days postoperatively. This reduces the effect of early deaths due to surgical and anesthesiologic complications as well as the higher degree of advanced directives present in the study population compared to the general population, which allowed for the evaluation of the long-term association between BB therapy and mortality in isolation. Results are reported as hazard ratios (HR) with 95% confidence intervals (CI). Statistical significance was defined as a 2-sided P value <.05.
A total of 134,915 cases were included in the study. After IPTW, BB therapy was associated with a 42% reduction the risk of mortality within the first postoperative year (adjusted HR = 0.58, 95% CI, 0.57-0.60; P < .001). After excluding patients who died within the first 30 days postoperatively, BB therapy was associated with a 27% reduction in the risk of mortality (adjusted HR = 0.73, 95% CI, 0.71-0.75; P < .001).
A significant reduction in the risk of mortality in the first year following hip fracture surgery was observed in patients with ongoing BB therapy. Further investigations into this finding are warranted.
在过去的 15 年中，许多国家的髋部骨折手术后第一年的高死亡率一直相对不变。最近的研究表明，β受体阻滞剂（BB）治疗与髋部骨折手术后 90 天内风险调整死亡率降低之间存在关联。我们假设术前和连续术后 BB 治疗也可能与髋部骨折手术后第一年的死亡率降低有关。
在这项回顾性队列研究中，纳入了 2008 年 1 月 1 日至 2017 年 12 月 31 日期间在瑞典接受初次急诊髋部骨折手术的所有成年人。排除了病理性骨折和保守治疗的髋部骨折患者。在手术前后一年内开处方的患者被定义为持续接受 BB 治疗。主要观察结果是术后一年内的死亡率。为了减少当前研究中由于非随机化引起的协变量混淆的影响，使用了逆概率治疗加权（IPTW）方法。随后，对加权队列进行了 Cox 比例风险模型拟合。当排除术后 30 天内死亡的患者时，重复了这些分析。这减少了由于手术和麻醉并发症导致的早期死亡以及研究人群中比一般人群更高程度的高级指令的影响，这使得可以评估 BB 治疗与死亡率之间的长期关联。结果以风险比（HR）和 95%置信区间（CI）表示。双侧 P 值 <.05 定义为统计学意义。
共有 134915 例患者纳入研究。经过 IPTW，BB 治疗与术后第一年死亡率降低 42%相关（调整后的 HR = 0.58，95%CI，0.57-0.60；P <.001）。排除术后 30 天内死亡的患者后，BB 治疗与死亡率降低 27%相关（调整后的 HR = 0.73，95%CI，0.71-0.75；P <.001）。
在髋部骨折手术后的第一年，持续接受 BB 治疗的患者的死亡率显著降低。需要进一步研究这一发现。
