Department of Orthopedic and Emergency Surgery, Alfried Krupp Hospital, 45276 Essen, Germany.
Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, 35043 Marburg, Germany.
Medicina (Kaunas). 2022 Nov 7;58(11):1610. doi: 10.3390/medicina58111610.
Fractures of the proximal femur are a life-changing and life-threatening event for older people. Concomitant malnutrition has been described as an independent risk factor for complications and mortality. Therefore, we examined the influence of albumin and body mass index (BMI) as parameters for the nutritional state on the outcome after geriatric hip fracture surgery. Data were retrospectively collected from hospital information systems, and complications and all other parameters were obtained from patient charts. We included patients aged 70 years or above with a fracture of the proximal femur. We excluded periprosthetic and peri-implant fractures and patients with a missing BMI or albumin value. Patients with a BMI below 20 kg/m were more likely to be female but did not differ from the normal BMI group in terms of baseline parameters. Patients with hypoalbuminemia had a higher ASA grade and Charlson Comorbidity Index, as well as a lower hemoglobin value and prothrombin time compared to those with normal albumin values and low BMI. Hypoalbuminemia was associated with significantly increased rates of complications (57.9% vs. 46.7%, = 0.04) and mortality (10.3% vs. 4.1%, = 0.02). Blood loss and transfusion rates were higher in the hypoalbuminemia group. Patients with a BMI below 20 kg/m had a higher risk of intraoperative cardiac arrest (2.6% vs. 0.4%, = 0.05) but did not show higher mortality rates than patients with a BMI above 20 kg/m. However, the outcome parameter could not be confirmed in the regression analysis. Hypoalbuminemia might be an indicator for more vulnerable patients with a compromised hemoglobin value, prothrombin time, and ASA grade. Therefore, it is also associated with higher mortality and postoperative complications. However, hypoalbuminemia was not an independent predictor for mortality or postoperative complications, but low albumin values were associated with a higher CCI and ASA grade than in patients with a BMI below 20 kg/m.
老年人股骨近端骨折是改变生活和危及生命的事件。营养不良已被描述为并发症和死亡率的独立危险因素。因此，我们研究了白蛋白和体重指数（BMI）作为营养状态参数对老年髋部骨折手术后结果的影响。数据从医院信息系统中回顾性收集，并发症和所有其他参数均从患者病历中获得。我们纳入了年龄在 70 岁及以上的股骨近端骨折患者。我们排除了假体周围和植入物周围骨折以及 BMI 或白蛋白值缺失的患者。BMI 低于 20 kg/m 的患者更可能为女性，但与正常 BMI 组在基线参数方面没有差异。低白蛋白血症患者的 ASA 分级和 Charlson 合并症指数较高，血红蛋白值和凝血酶原时间较低，与正常白蛋白值和低 BMI 患者相比。低白蛋白血症与并发症发生率显著增加相关（57.9%比 46.7%，=0.04）和死亡率（10.3%比 4.1%，=0.02）。低白蛋白血症组的失血量和输血率较高。BMI 低于 20 kg/m 的患者术中发生心脏骤停的风险更高（2.6%比 0.4%，=0.05），但死亡率并不高于 BMI 高于 20 kg/m 的患者。然而，在回归分析中无法确认结果参数。低白蛋白血症可能是血红蛋白值、凝血酶原时间和 ASA 分级受损的脆弱患者的指标。因此，它也与更高的死亡率和术后并发症相关。然而，低白蛋白血症不是死亡率或术后并发症的独立预测因素，但与 BMI 低于 20 kg/m 的患者相比，低白蛋白血症患者的 CCI 和 ASA 分级更高。
