Trauma/Critical Care, Ocala Regional Medical Center, Ocala, FL, USA.
University of Central Florida College of Medicine/HCA GME Consortium - Ocala, Ocala, FL, USA.
Am Surg. 2023 May;89(5):1479-1484. doi: 10.1177/00031348211058629. Epub 2021 Dec 14.
Isolated hip fractures (IHFs) are a cause of morbidity and mortality in the geriatric population aged >65 years. Frailty has been identified as a determinant for patient outcomes in other surgical specialties. The purpose of this study is to determine if frailty severity is a predictor of outcomes in IHF in the geriatric population.
This is a retrospective study in a state and ACS Level 2 trauma center. Patients with IHF were reviewed between January 2018 and January 2020. Primary outcome was in-patient mortality. Secondary outcomes include perioperative outcome measures such as UTI, HCAP, DVT, readmission, length of stay, ICU length of stay, nutritional status, and discharge destination. Patients were stratified into mild (1-2), moderate (3-5), and severe (5-7) frailty using the Rockwood Frailty Score (RFS). Clinical characteristics and outcomes were analyzed.
We identified 470 patients with IHF who were stratified by mild (N=316), moderate (N-123), and severe (N=31) frailty. Frailty worsened with increasing age (P < .0001). Those who were less frail were more likely discharged home (P < .04). Severely frail patients were more likely discharged to hospice (P < .01). Severely frail patients also were more likely to develop DVT (P < .04) and have poorer nutritional status (P < .02). There were no differences among groups for in-patient mortality.
Severely frail patients are more likely to be malnourished at baseline and be discharged to hospice care. The RFS is a reliable objective tool to identify high-risk patients and guide goals of care discussion for operative intervention in isolated traumatic hip fractures.
孤立性髋部骨折（IHF）是导致 65 岁以上老年人群发病率和死亡率的原因。虚弱已被确定为其他外科专业患者结局的决定因素。本研究旨在确定虚弱严重程度是否是老年人群 IHF 结局的预测因素。
这是在州和 ACS 二级创伤中心进行的回顾性研究。对 2018 年 1 月至 2020 年 1 月期间患有 IHF 的患者进行了回顾性研究。主要结局是住院死亡率。次要结局包括围手术期结局指标，如尿路感染、医院获得性肺炎、深静脉血栓形成、再入院、住院时间、重症监护病房住院时间、营养状况和出院去向。患者使用 Rockwood 虚弱评分（RFS）分为轻度（1-2 分）、中度（3-5 分）和重度（5-7 分）虚弱。分析了临床特征和结局。
我们确定了 470 例 IHF 患者，他们的虚弱程度分别为轻度（N=316）、中度（N=123）和重度（N=31）。虚弱程度随年龄的增加而恶化（P<.0001）。虚弱程度较低的患者更有可能出院回家（P<.04）。严重虚弱的患者更有可能被送往临终关怀机构（P<.01）。严重虚弱的患者也更容易发生深静脉血栓形成（P<.04）和营养状况较差（P<.02）。各组之间的住院死亡率无差异。
严重虚弱的患者在基线时更有可能营养不良，并被送往临终关怀机构。RFS 是一种可靠的客观工具，可以识别高风险患者，并指导孤立性创伤性髋部骨折手术干预的目标护理讨论。
