Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark.
Injury. 2022 Jun;53(6):2150-2157. doi: 10.1016/j.injury.2022.03.015. Epub 2022 Mar 9.
The aim of this study was to investigate the association between Parkinson's disease (PD) and postoperative complications, mortality, and quality of in-hospital care in patients with hip fracture.
We included patients aged 65+ years with an incident hip fracture from 2004-2017, registered in the Danish Multidisciplinary Hip Fracture Registry. Patients with PD were identified using diagnosis codes prior to hip fracture. Using log-binomial regression, we calculated both 30-day crude and adjusted risk ratios (aRR) with 95% confidence intervals (CIs) for the following outcomes: any hospital-treated infections, pneumonia, urinary tract infection, sepsis, community-treated infections, cardiovascular events, mortality, and fulfilment of quality indicators of in-hospital care. Analyses were adjusted for age, sex and Charlson comorbidity index score.
We identified 77,550 hip fracture patients of which 1,915 had PD. Compared to non-PD, patients with PD had higher risk of any hospital-treated - (aRR = 1.27 (CI: 1.10-1.45) and community-treated infection (aRR = 1.22 (CI: 1.13-1.32)), pneumonia (aRR = 1.38 (1.11-1.69)), urinary tract infection (aRR of 1.58 (CI: 1.28-1.92)) and sepsis (aRR = 1.18 (CI: 0.67-1.89)), but a reduced risk of cardiovascular events (aRR = 0.59 (CI: 0.41-0.82)). The aRR for 30-day mortality was 1.11 (CI: 0.97-1.27) for PD vs non-PD patients, and the aHR for 1-year mortality was 1.19 (CI: 1.09-1.30). The aRRs for fulfillment of all relevant quality indicators was about 1 for PD vs non-PD patients.
Hip fracture patients with PD have a higher risk of infections and mortality within 30 days after surgery after adjustment for sex, age, and comorbidity. They do, however, receive comparable quality of in-hospital care after hip fracture compared to non-PD patients.
本研究旨在探讨帕金森病（PD）与髋部骨折患者术后并发症、死亡率和住院期间护理质量之间的关系。
我们纳入了 2004 年至 2017 年期间年龄在 65 岁以上、初次发生髋部骨折的患者，并在丹麦多学科髋部骨折登记处进行了登记。PD 患者是通过骨折前的诊断代码确定的。使用对数二项式回归，我们计算了以下结果的 30 天粗风险比（crude risk ratio，CRR）和调整后的风险比（adjusted risk ratio，aRR），95%置信区间（confidence intervals，CI）：任何医院治疗的感染、肺炎、尿路感染、败血症、社区治疗的感染、心血管事件、死亡率和住院期间护理质量指标的达标情况。分析调整了年龄、性别和 Charlson 合并症指数评分。
我们共确定了 77550 例髋部骨折患者，其中 1915 例患有 PD。与非 PD 患者相比，PD 患者发生任何医院治疗的感染（aRR=1.27（95%CI：1.10-1.45）和社区治疗的感染（aRR=1.22（95%CI：1.13-1.32）、肺炎（aRR=1.38（95%CI：1.11-1.69）、尿路感染（aRR=1.58（95%CI：1.28-1.92）和败血症（aRR=1.18（95%CI：0.67-1.89）的风险更高，但发生心血管事件的风险更低（aRR=0.59（95%CI：0.41-0.82）。PD 患者与非 PD 患者的 30 天死亡率的 aRR 为 1.11（95%CI：0.97-1.27），1 年死亡率的 aHR 为 1.19（95%CI：1.09-1.30）。PD 患者与非 PD 患者所有相关质量指标的达标率约为 1。
调整性别、年龄和合并症后，PD 患者在髋部骨折手术后 30 天内发生感染和死亡的风险更高。然而，与非 PD 患者相比，PD 患者在髋部骨折后接受的住院期间护理质量相当。
