Chiang Ming-Hsiu, Lee Huan-Ju, Kuo Yi-Jie, Chien Pei-Chun, Chang Wei-Chun, Wu Yueh, Chen Yu-Pin
Department of General Medicine, Chang Gung Memorial Hospital Kaohsiung Branch, Kaohsiung, Taiwan.
Department of Orthopedics, Taipei Medical University Shuan Ho Hospital, New Taipei City, Taiwan.
Geriatr Orthop Surg Rehabil. 2021 Oct 5;12:21514593211044644. doi: 10.1177/21514593211044644. eCollection 2021.
Although surgery has been proven to improve the long-term survival of older adults with hip fracture, in-hospital mortality directly resulting from repair of hip fracture is undesirable. This study aimed to identify potential prognostic factors that predict in-hospital mortality risk in elderly patients following hip fracture surgery. This case-control study comprehensively collected data from older adults with hip fracture admitted to a single medical centre. Age was selected as the cross-matching factor. Univariate and binary multivariate logistic regression models were used to estimate the odds ratios with 95% confidence intervals. A receiver operating characteristic curve was constructed to quantify the discrimination power of the model. Among a total of 841 older adults who received hip fracture surgery, 17 died during hospitalisation, yielding a 2.0% in-hospital mortality rate. Using a binary multivariate logistic regression model to perform a comparison with 51 age-matched patients in survival groups, the model revealed that estimated glomerular filtration rate (eGFR) and malignant cancer history were the only 2 factors significantly correlated with in-hospital mortality. The prognostic values for the eGFR and malignant cancer history were acceptable, with areas under the curve of .76 and .67, respectively. The prevalence of in-hospital mortality following hip fracture is low. After adjustment for age, eGFR and malignant cancer history were identified as factors significantly correlated with in-hospital mortality. The findings of this study could assist in the early screening and detection of patients with high in-hospital mortality risks.
尽管手术已被证明可提高老年髋部骨折患者的长期生存率,但髋部骨折修复直接导致的住院死亡率却不尽人意。本研究旨在确定预测老年髋部骨折手术后住院死亡风险的潜在预后因素。这项病例对照研究全面收集了一家医疗中心收治的老年髋部骨折患者的数据。选择年龄作为匹配因素。采用单因素和二元多因素逻辑回归模型来估计比值比及其95%置信区间。构建受试者工作特征曲线以量化模型的辨别力。在总共841例接受髋部骨折手术的老年人中,17例在住院期间死亡,住院死亡率为2.0%。使用二元多因素逻辑回归模型对51例年龄匹配的生存组患者进行比较,该模型显示估计肾小球滤过率(eGFR)和恶性肿瘤病史是仅有的2个与住院死亡率显著相关的因素。eGFR和恶性肿瘤病史的预后价值尚可,曲线下面积分别为0.76和0.67。髋部骨折后住院死亡率较低。在对年龄进行调整后,eGFR和恶性肿瘤病史被确定为与住院死亡率显著相关的因素。本研究结果有助于早期筛查和发现住院死亡风险高的患者。