Zhou Y F, Pu L F, Lin Q C, Yuan K M, Li J
Department of Anesthesiology and Perioperative Medicine, the Second Affiliated Hospital & Yuying Children's Hospital, Wenzhou Medical University, Wenzhou 325027, China.
The People's Hospital of Shaoxing, Shaoxing 312000, China.
Zhonghua Yi Xue Za Zhi. 2021 May 11;101(17):1269-1274. doi: 10.3760/cma.j.cn112137-20200908-02601.
To analyze the related factors that affect the one-year mortality in elderly patients following hip fracture surgery. The clinical data of the elderly patients who needed a surgery for hip fracture in the Second Affiliated Hospital of Wenzhou Medical University from January 2017 to April 2018 were retrospectively analyzed. According to the inclusion criteria of the study, 489 cases were included. Then the information of patients including age, sex, Charlson comorbidity index, type of fracture, Braden score at admission, American Society of Anesthesiologists (ASA) score, length of hospital stay, type of anesthesia, whole blood cells analysis were collected. Univariate and multivariate Cox regression analyses were conducted to investigate the factors related to one-year mortality of patients. After excluding 39 patients, 450 patients were finally included. Patients in this cohort study had a mortality rate of 3.33% (15/450) at 1 month, 7.78% (35/450) at half a year, and 10.89% (49/450) at 1 year after surgery. Univariate analysis showed that age, sex, ASA score, type of fracture, Charlson comorbidity index, Braden score at admission, type of analgesia, preoperative hemoglobin concentration, preoperative albumin concentration, postoperative delirium of high activity correlated with one-year mortality after surgery. Further, multivariate Cox regression analysis revealed that age>80 years old (=2.32, 95%: 1.11-4.85, =0.025), Charlson comorbidity index ≥ 3 (=3.24, 95%:1.75-6.03, <0.001), Braden score at admission ≤16 (=1.93, 95%:1.03-3.57, =0.040) and postoperative delirium of high activity (=2.49, 95%:1.16-5.35, =0.019) were risk factors for one-year mortality. The current study indicates that one-year mortality rate of elderly patients following hip fracture surgery is 10.89%. Meanwhile, age>80 years, Charlson comorbidity index ≥ 3, Braden score at admission ≤ 16, postoperative delirium of high activity are risk factors for one-year mortality.
分析影响老年髋部骨折手术患者1年死亡率的相关因素。回顾性分析2017年1月至2018年4月在温州医科大学附属第二医院需行髋部骨折手术的老年患者的临床资料。根据研究纳入标准，纳入489例患者。然后收集患者的年龄、性别、Charlson合并症指数、骨折类型、入院时Braden评分、美国麻醉医师协会（ASA）评分、住院时间、麻醉方式、全血细胞分析等信息。进行单因素和多因素Cox回归分析以探究与患者1年死亡率相关的因素。排除39例患者后，最终纳入450例患者。该队列研究中的患者术后1个月死亡率为3.33%（15/450），半年时为7.78%（35/450），1年时为10.89%（49/450）。单因素分析显示，年龄、性别、ASA评分、骨折类型、Charlson合并症指数、入院时Braden评分、镇痛方式、术前血红蛋白浓度、术前白蛋白浓度、术后高活动型谵妄与术后1年死亡率相关。进一步的多因素Cox回归分析显示，年龄>80岁（=2.32，95%：1.11 - 4.85，=0.025）、Charlson合并症指数≥3（=3.24，95%：1.75 - 6.03，<0.001）、入院时Braden评分≤16（=1.93，95%：1.03 - 3.57，=0.040）和术后高活动型谵妄（=2.49，95%：1.16 - 5.35，=0.019）是1年死亡率的危险因素。本研究表明，老年髋部骨折手术患者的1年死亡率为10.89%。同时，年龄>80岁、Charlson合并症指数≥3、入院时Braden评分≤16、术后高活动型谵妄是1年死亡率的危险因素。
