Ruiz-Romero M V, Calero-Bernal M L, Carranza-Galván A B, Fernández-Moyano A, Blanco-Taboada A L, Fernández-Ojeda M R
Unidad de Calidad, Hospital San Juan de Dios del Aljarafe, Bormujos, Sevilla, España.
Servicio de Medicina Interna, Hospital San Juan de Dios del Aljarafe, Bormujos, Sevilla, España.
J Healthc Qual Res. 2022 Sep-Oct;37(5):303-312. doi: 10.1016/j.jhqr.2021.11.004. Epub 2022 Feb 11.
Hip fracture in the elderly leads to long hospital stays, readmissions and mortality.
To identify risk factors associated with mortality and readmissions in elderly with hip fracture.
Prospective observational study in people over 65years with hip fracture between October-2017 and November-2018, followed for 12months (128 patients).
SPSS vs27.0.
6 (4.7%) patients were readmitted at 1 month; at year 24 (19.4%); 55 (44.4%) consulted for emergencies; 4 (3.1%) died during admission, and 26 (20.3%) in 12months; hospital stay 6.5 (SD: 4.80) days. Those with a previous Barthel less than 85 (6 [8.5%] vs 0 [0%]; P=.037) and less EuroQol5D (6 [10.0] vs 0 [0%]; P=.011) were readmitted more at one month. Those taking anticoagulants (OR: 3.33 (1.13-9.81); P=.003) and those with high surgical risk (18 [23.4%] vs 1 [5.6%]) were readmitted more after one year; P=.038). There was higher intra-episode mortality with renal failure (OR: 34.2 [3.25-359.93]; P=.003) and decompensated heart failure (OR: 23.8 [2.76-205.25]; P=.015). Higher mortality at one year in those older than 85years (OR: 4.3 [1.48-12.49]; P=.007); in those taking benzodiazepines (OR: 2.86 [1.06-7.73]; P=.038); if Barthel was less than 85 (OR: 2.96 [1.1-7.99]; P=.027) and if EuroQol5D was low (0.249 vs 0.547; P=.025). Those operated after 72h (24 [57.1%] vs. 29 [38.2%]; P=.047) consulted more for the emergency department.
Renal failure and cardiac decompensation increased intra-episode mortality. Older age, benzodiazepines, and previous low functionality and low EuroQol5D increased mortality at one year. They were readmitted more if higher surgical risk, previously anticoagulated and worse quality of life and functionality.
老年髋部骨折会导致住院时间延长、再次入院及死亡。
确定老年髋部骨折患者死亡和再次入院的相关危险因素。
对2017年10月至2018年11月期间65岁以上髋部骨折患者进行前瞻性观察研究，随访12个月（128例患者）。
采用SPSS 27.0。
6例（4.7%）患者在1个月时再次入院；24例（19.4%）在1年时再次入院；55例（44.4%）因急诊就诊；4例（3.1%）在住院期间死亡，26例（20.3%）在12个月内死亡；住院时间为6.5（标准差：4.80）天。既往Barthel指数低于85分的患者（6例[8.5%]对0例[0%]；P = 0.037）和EuroQol5D评分较低的患者（6例[10.0]对0例[0%]；P = 0.011）在1个月时再次入院的情况更多。服用抗凝剂的患者（比值比：3.33[1.13 - 9.81]；P = 0.003）和手术风险高的患者（18例[23.4%]对1例[5.6%]；P = 0.038）在1年后再次入院的情况更多。肾衰竭（比值比：34.2[3.25 - 359.93]；P = 0.003）和失代偿性心力衰竭（比值比：23.8[2.76 - 205.25]；P = 0.015）患者的住院期间死亡率更高。85岁以上患者1年时死亡率更高（比值比：4.3[1.48 - 12.49]；P = 0.007）；服用苯二氮䓬类药物的患者（比值比：2.86[1.06 - 7.73]；P = 0.038）；如果Barthel指数低于85分（比值比：2.96[1.1 - 7.99]；P = 0.027）以及如果EuroQol5D评分较低（0.249对0.547；P = 0.025）。72小时后接受手术的患者（24例[57.1%]对29例[38.2%]；P = 0.047）到急诊科就诊的情况更多。
肾衰竭和心脏失代偿增加了住院期间死亡率。高龄、苯二氮䓬类药物、既往功能低下和EuroQol5D评分低增加了1年时的死亡率。手术风险较高、既往接受抗凝治疗以及生活质量和功能较差的患者再次入院的情况更多。
