肩部半关节置换术治疗骨折后死亡和再入院的危险因素
Risk Factors for Mortality and Readmission After Shoulder Hemiarthroplasty for Fracture.
作者信息
Singh Anshuman, Schultzel Mark, Cafri Guy, Yian Edward H, Dillon Mark T, Navarro Ronald A
机构信息
Southern California Permanente Medical Group, Department of Orthopaedics, San Diego, California.
Surgical Outcomes and Analysis, Kaiser Permanente, San Diego, California.
出版信息
J Shoulder Elb Arthroplast. 2019 Apr 23;3:2471549219840441. doi: 10.1177/2471549219840441. eCollection 2019.
BACKGROUND
Limited information exists regarding mortality and readmission following proximal humerus fracture. This study examines risk factors following hemiarthroplasty for these fractures.
METHODS
A retrospective analysis of prospectively collected data on 788 patients treated with hemiarthroplasty for acute proximal humerus fracture from January 2005 to December 2011 was conducted. One-year mortality and 30- and 90-day hospital readmission were evaluated. Patient risk factors included age, race, gender, diabetes, American Society of Anesthesiologists (ASA) score, and body mass index.
RESULTS
One-year mortality rate was 5.2%. Patients with ASA ≥3 had 2.37 times (95% confidence interval [CI]: 1.05-5.32) greater mortality risk versus patients with ASA1/2. The 30-day readmission rate was 8.4% and at 90 days was 12.6%. Females had 0.53 risk of readmission versus males (95% CI: 0.29-0.96). Patients with ASA ≥3 had 1.79 (95% CI: 1.04-3.09) risk of 90-day readmission versus patients with ASA1/2; females had 0.52 (95% CI: 0.31-0.85) risk of readmission versus males. Increased age increased all odds ratios.
CONCLUSIONS
Readmission rate after hemiarthroplasty for proximal humerus fracture is significant both at 30 and 90 days and is higher in males. Age and ASA ≥3 correlate with this. Diabetes and obesity were not significant risk factors for readmission or mortality.
背景
关于肱骨近端骨折后的死亡率和再入院情况，现有信息有限。本研究探讨了这些骨折行半关节置换术后的危险因素。
方法
对2005年1月至2011年12月期间788例行急性肱骨近端骨折半关节置换术患者的前瞻性收集数据进行回顾性分析。评估了1年死亡率以及30天和90天的医院再入院情况。患者危险因素包括年龄、种族、性别、糖尿病、美国麻醉医师协会（ASA）评分和体重指数。
结果
1年死亡率为5.2%。ASA≥3的患者与ASA1/2的患者相比，死亡风险高2.37倍（95%置信区间[CI]：1.05 - 5.32）。30天再入院率为8.4%，90天为12.6%。女性再入院风险是男性的0.53倍（95% CI：0.29 - 0.96）。ASA≥3的患者与ASA1/2的患者相比，90天再入院风险为1.79（95% CI：1.04 - 3.09）；女性再入院风险是男性的0.52倍（95% CI：0.31 - 0.85）。年龄增加会使所有比值比升高。
结论
肱骨近端骨折半关节置换术后30天和90天的再入院率均较高，且男性更高。年龄和ASA≥3与之相关。糖尿病和肥胖并非再入院或死亡的显著危险因素。
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