Yang Xi, Qin Zhijun, Li Yi, Deng Yang, Li Man
Intensive Care Unit, Sichuan Provincial Orthopedic Hospital, Chengdu, 610041, Sichuan Province, China.
Department of Anesthesia, Sichuan Provincial Orthopedic Hospital, Chengdu, 610041, Sichuan Province, China.
Heliyon. 2022 Aug 13;8(8):e10202. doi: 10.1016/j.heliyon.2022.e10202. eCollection 2022 Aug.
Hip fractures occurring in older patients often result in significant anemia, even hemodynamic disorders and hypoperfusion. The present study aims to investigate the general characteristics of hypotension following hip fracture surgery (HFHFS) and its effect on clinical outcomes.
A total of 168 patients aged ≥80 years who underwent hip fracture surgery at a tertiary orthopaedic hospital from January 1, 2020 to August 31, 2020 were enrolled and followed up for one year. Patients were divided into HFHFS and non-HFHFS cohorts according to blood pressure within 24 h after surgery. General difference comparison, univariate and multivariate regression, and survival analysis were applied to investigate the association between HSHSF and in-hospital and one-year clinical outcomes.
The incidence of HFHFS was 23.8% (40/168), with a median time to onset of 8.0 (5.0-12.0) hours after surgery. The HFHFS group had more chronic heart disease before injury and experienced more positive fluid balance on the day of surgery (P values were 0.032 and 0.028, respectively). After adjustment for potential confounders, HFHFS was associated with prolonged length of hospital stay (B 2.66, 95% CI 0.22, 5.10; P = 0.033), postoperative cardiac dysfunction (OR 2.92, 95% CI 1.05, 8.11; P = 0.039), and postoperative brain dysfunction (OR 3.51, 95% CI 1.50, 8.23; P = 0.004). HFHFS had no effect on one-year modified Rankin Scale (mRS) (B 0.28, 95% CI -0.28, 0.84; P = 0.322) and one-year mortality (HR 1.07, 95% CI 0.29, 3.96; P = 0.917).
Many older patients develop hypotension several hours after hip fracture surgery, which may be related with preexisting decline in cardiac reserve in addition to postoperative hidden blood loss. Patients who experienced HFHFS were more likely to have postoperative cardiac and brain dysfunction and longer hospital stay. However, HFHFS had no significant effect on mRS and mortality at one year.
老年患者发生髋部骨折常导致严重贫血，甚至出现血流动力学紊乱和灌注不足。本研究旨在探讨髋部骨折手术后低血压（HFHFS）的一般特征及其对临床结局的影响。
选取2020年1月1日至2020年8月31日在一家三级骨科医院接受髋部骨折手术的168例年龄≥80岁的患者进行为期一年的随访。根据术后24小时内的血压将患者分为HFHFS组和非HFHFS组。采用一般差异比较、单因素和多因素回归以及生存分析来研究HFHFS与住院期间及一年临床结局之间的关联。
HFHFS的发生率为23.8%（40/168），发病中位时间为术后8.0（5.0 - 12.0）小时。HFHFS组受伤前患有慢性心脏病的患者更多，且手术当天液体正平衡情况更明显（P值分别为0.032和0.028）。在对潜在混杂因素进行调整后，HFHFS与住院时间延长相关（B 2.66，95%CI 0.22，5.10；P = 0.033）、术后心脏功能障碍（OR 2.92，95%CI 1.05，8.11；P = 0.039）和术后脑功能障碍（OR 3.51，95%CI 1.50，8.23；P = 0.004）。HFHFS对一年改良Rankin量表（mRS）（B 0.28，95%CI -0.28，0.84；P = 0.322）和一年死亡率（HR 1.07，95%CI 0.29，3.96；P = 0.917）无影响。
许多老年患者在髋部骨折手术后数小时出现低血压，这除了与术后隐匿性失血有关外，可能还与术前已存在的心脏储备功能下降有关。发生HFHFS的患者术后更易出现心脏和脑功能障碍，住院时间更长。然而，HFHFS对一年时的mRS和死亡率无显著影响。
