Department of Orthopaedics, Gødstrup Hospital, University Clinic of Hand, Hip and Knee Surgery, Herning, Denmark.
Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
Eur Geriatr Med. 2022 Apr;13(2):433-443. doi: 10.1007/s41999-021-00598-x. Epub 2021 Dec 2.
Despite extensive research, a complete understanding of factors influencing mortality risk after hip fractures is lacking. Previous research has focused on static risk factors; however, to improve outcomes, attention should be directed towards risk factors that may be optimised. The present study aimed to investigate the association of 19 risk factors with mortality among patients with hip fracture treated according to a well-defined guideline.
The study was a retrospective analysis of a large prospective patient cohort with all consecutive patients surgically treated for a hip fracture from January 2011 to December 2017 included (n = 2800). Variables were obtained from patient records and the Holstebro Hip Fracture Database comprising prospectively registered data on demographics, comorbidity, malnutrition (low Body Mass Index (BMI) or albumin) and hospital stay (including fracture and surgical data, biochemistry, mobilisation and discharge). Outcomes were 30-day and one-year mortality.
Patients were predominantly female (66%); median age 81.6 years. Overall mortality was 9% at 30 days and 24% at one year. Age ≥ 75 years, male gender, nursing home residence, cognitive impairment, American Society of Anesthesiologists (ASA) score ≥ 3, BMI < 20 kg/m, albumin < 35 g/l, creatinine ≥ 100 µmol/l, a low New Mobility Score and no mobilisation were all associated with increased mortality at 30 days and one year.
In addition to non-modifiable risk factors, comorbidities (expressed as high ASA score and creatinine), malnutrition, and failure to achieve early post-operative mobilisation were associated with increased short and long-term mortality among patients with hip fracture: these are potentially modifiable. The effect of optimisation interventions warrants further research.
尽管进行了广泛的研究，但仍缺乏对影响髋部骨折后死亡率的因素的全面了解。 之前的研究侧重于静态风险因素；然而，为了改善结果，应关注可能优化的风险因素。本研究旨在调查 19 个风险因素与按照明确指南治疗的髋部骨折患者的死亡率之间的关系。
这是一项对大型前瞻性患者队列的回顾性分析，该队列包括 2011 年 1 月至 2017 年 12 月期间所有连续接受髋部骨折手术治疗的患者（n=2800）。变量从病历和 Holstebro 髋部骨折数据库中获得，该数据库包含人口统计学、合并症、营养不良（低体重指数（BMI）或白蛋白）和住院时间（包括骨折和手术数据、生物化学、活动能力和出院）的前瞻性登记数据。结果是 30 天和一年的死亡率。
患者主要为女性（66%）；中位年龄为 81.6 岁。30 天总死亡率为 9%，1 年死亡率为 24%。年龄≥75 岁、男性、疗养院居住、认知障碍、美国麻醉医师协会（ASA）评分≥3、BMI<20kg/m、白蛋白<35g/l、肌酐≥100µmol/l、新活动能力评分低且无法活动均与 30 天和 1 年死亡率增加相关。
除了不可改变的风险因素外，合并症（表现为高 ASA 评分和肌酐）、营养不良以及未能实现术后早期活动与髋部骨折患者的短期和长期死亡率增加相关：这些是潜在可改变的。优化干预措施的效果需要进一步研究。
