Huyke-Hernández Fernando A, Parashos Sotirios A, Schroder Lisa K, Switzer Julie A
Department of Orthopaedic Surgery, Park Nicollet Methodist Hospital, St. Louis Park, MN, USA.
Department of Orthopaedic Surgery, TRIA Orthopaedic Institute, Bloomington, MN, USA.
Geriatr Orthop Surg Rehabil. 2022 Aug 8;13:21514593221118225. doi: 10.1177/21514593221118225. eCollection 2022.
Compared to other patients, Parkinson disease (PD) patients may experience suboptimal outcomes after hip fracture. The purpose of this study was to describe and compare characteristics and outcomes of hip fracture patients with PD to those without PD.
This retrospective cohort study included all patients admitted for hip fracture within a large healthcare system between July 1, 2017 and June 30, 2019. Demographics, injury characteristics, Charlson Comorbidity Index (CCI), treatment characteristics, and outcomes including complications, readmissions, and mortality were extracted. Patients with PD were compared to those without PD. Chi-square tests, two-sample t-tests, and Fisher exact tests were conducted to identify group differences.
A total of 1239 patients were included (4.0% PD and 96.0% non-PD). PD patients were mostly male (59.2%) compared to mostly female non-PD patients 69.4%, < .001). PD patients on average had a higher CCI (2.3 vs 1.7, = .040) and more frequently had dementia (42.9% vs 26.7%, = .013). No PD patients were discharged home without additional assistance compared to 8.1% of patients without PD. More PD patients were discharged to a skilled nursing facility (SNF) than non-PD patients (65.3% vs 48.2%, = .021). Only 22.4% of PD patients were previously prescribed osteoporosis medication, and only 16.3% were referred for osteoporosis follow-up after fracture. In-house complications, readmissions, and mortality up to 1 year were comparable between groups (>.191).
Outcomes between PD patients and non-PD patients were mostly equivalent, but more PD patients required discharge to a higher-level care environment compared to non-PD patients. Although PD seems to be a risk factor for hip fracture regardless of age and sex, most patients had not undergone proper screening or preventative treatment for osteoporosis. These results emphasize the need for early bone health evaluation, multidisciplinary collaboration, and care coordination in preventing and treating hip fractures in PD.
与其他患者相比，帕金森病（PD）患者髋部骨折后的预后可能不太理想。本研究的目的是描述和比较患有PD的髋部骨折患者与未患PD的患者的特征和预后。
这项回顾性队列研究纳入了2017年7月1日至2019年6月30日期间在一个大型医疗系统中因髋部骨折入院的所有患者。提取了人口统计学、损伤特征、查尔森合并症指数（CCI）、治疗特征以及包括并发症、再入院和死亡率在内的预后信息。将患有PD的患者与未患PD的患者进行比较。进行卡方检验、两样本t检验和Fisher精确检验以确定组间差异。
共纳入1239例患者（4.0%患有PD，96.0%未患PD）。与未患PD的女性患者居多（69.4%）相比，患有PD的患者大多为男性（59.2%），P <.001）。患有PD的患者平均CCI较高（2.3对1.7，P =.040），且患痴呆症的频率更高（42.9%对26.7%，P =.013）。与8.1%未患PD的患者相比，没有患有PD的患者在无需额外帮助的情况下出院回家。与未患PD的患者相比，更多患有PD的患者被转至专业护理机构（SNF）（65.3%对48.2%，P =.021）。只有22.4%患有PD的患者之前曾开具过骨质疏松症药物，骨折后只有16.3%的患者被转诊进行骨质疏松症随访。两组之间的院内并发症、再入院率和1年内的死亡率相当（P>.191）。
患有PD的患者和未患PD的患者的预后大多相当，但与未患PD的患者相比，更多患有PD的患者需要转至更高水平的护理环境。尽管无论年龄和性别，PD似乎都是髋部骨折的一个危险因素，但大多数患者尚未接受过适当的骨质疏松症筛查或预防性治疗。这些结果强调了在预防和治疗PD患者的髋部骨折方面进行早期骨骼健康评估、多学科协作和护理协调的必要性。
