老年人下颌骨骨折修复：年龄与不良结局相关吗？
Mandibular Fracture Repair in Older Adults: Is Age Associated With Adverse Outcomes?
机构信息
Resident, Oral & Maxillofacial Surgery, Massachusetts General Hospital and Harvard School of Dental Medicine, Boston, MA.
Instructor, Oral & Maxillofacial Surgery, Massachusetts General Hospital and Harvard School of Dental Medicine, Boston, MA.
出版信息
J Oral Maxillofac Surg. 2022 Jun;80(6):1040-1052. doi: 10.1016/j.joms.2022.01.015. Epub 2022 Jan 26.
PURPOSE
The purpose of this study was to measure the association between age and adverse outcomes in patients undergoing open reduction internal fixation (ORIF) of mandibular fractures.
METHODS
This was a retrospective cohort study utilizing the American College of Surgeons National Surgical Quality Improvement Program databases (2011 to 2019) to identify patients with mandibular fractures treated with ORIF. The primary predictor variable was age (<45 years, 45 to 54 years, 55 to 64 years, 65 to 74 years, and ≥75 years). The primary outcome variable was surgical complications. Secondary outcome variables included any complication, extended length of stay (LOS ≥95 percentile), and adverse discharge destination. Covariates included demographic, medical, and perioperative covariates. Descriptive, bivariate, and multiple logistic regression statistics were utilized to evaluate the association between age and adverse outcomes.
RESULTS
During the study period, 2,843 patients underwent ORIF of a mandibular fracture, and 2,168 subjects were included. There were 1,673 subjects aged <45 years (77.2%), 240 subjects aged 45 to 54 years (11.1%), 155 subjects aged 55 to 64 years (7.10%), 53 subjects aged 65 to 74 years (2.40%), and 47 subjects aged ≥75 years (2.20%). A total of 148 subjects (6.83%) experienced a surgical complication; the incidence of surgical complications increased in a step-wise fashion with each decade of life (P ≤ .001). In bivariate analysis, subjects aged 65 to 74 years were more likely to experience extended LOS (P = .004), whereas subjects aged ≥75 years were more likely to have an extended LOS (P ≤ .001) and an adverse discharge destination (P ≤ .001). In multivariate analysis, age 65 to 74 years was an independent predictor of any complication (P = .032, 95% confidence interval [CI] = 1.08 to 5.37), extended LOS (P = .001, 95% CI = 1.72 to 8.79), and adverse discharge destination (P = .050, 95% CI = 1.00 to 14.4), whereas age ≥75 years was an independent predictor of surgical complications (P = .043, 95% CI = 1.03 to 6.68), any complication (P = .018, 95% CI = 1.20 to 6.75), extended LOS (P = .001, 95% CI = 2.35 to 12.3), and an adverse discharge destination (P ≤ .001, 95% CI = 3.01 to 33.2).
CONCLUSIONS
The elderly are at increased risk of adverse outcomes with step-wise increases in the odds of select outcomes with increasing age.
目的
本研究旨在衡量年龄与接受下颌骨切开复位内固定术（ORIF）治疗的患者不良结局之间的关联。
方法
这是一项回顾性队列研究，利用美国外科医师学会国家手术质量改进计划数据库（2011 年至 2019 年）确定接受 ORIF 治疗的下颌骨骨折患者。主要预测变量为年龄（<45 岁、45 岁至 54 岁、55 岁至 64 岁、65 岁至 74 岁和≥75 岁）。主要结局变量是手术并发症。次要结局变量包括任何并发症、延长住院时间（LOS≥95 百分位）和不良出院目的地。协变量包括人口统计学、医疗和围手术期协变量。使用描述性、双变量和多逻辑回归统计数据评估年龄与不良结局之间的关联。
结果
在研究期间，2843 例患者接受了下颌骨骨折的 ORIF，其中 2168 例患者入选。1673 例患者年龄<45 岁（77.2%），240 例患者年龄 45 岁至 54 岁（11.1%），155 例患者年龄 55 岁至 64 岁（7.10%），53 例患者年龄 65 岁至 74 岁（2.40%），47 例患者年龄≥75 岁（2.20%）。共有 148 例患者（6.83%）发生手术并发症；手术并发症的发生率呈阶梯式上升，与每个十年的生命阶段呈正相关（P≤0.001）。在双变量分析中，65 岁至 74 岁的患者更有可能延长 LOS（P=0.004），而≥75 岁的患者更有可能延长 LOS（P≤0.001）和不良出院目的地（P≤0.001）。在多变量分析中，65 岁至 74 岁是任何并发症的独立预测因素（P=0.032，95%置信区间[CI]1.08 至 5.37），延长 LOS（P=0.001，95%CI1.72 至 8.79）和不良出院目的地（P=0.050，95%CI1.00 至 14.4），而≥75 岁是手术并发症的独立预测因素（P=0.043，95%CI1.03 至 6.68）、任何并发症（P=0.018，95%CI1.20 至 6.75）、延长 LOS（P=0.001，95%CI2.35 至 12.3）和不良出院目的地（P≤0.001，95%CI3.01 至 33.2）。
结论
老年人发生不良结局的风险增加，随着年龄的增长，选择结局的几率呈阶梯式上升。
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