在 COVID-19 大流行期间行髋关节置换术后老年髋部骨折患者的术后医疗发病率和 3 个月死亡率的危险因素。
Risk factors for postoperative medical morbidity and 3-month mortality in elderly patients with hip fracture following hip arthroplasty during COVID-19 pandemic.
机构信息
Department of Joint Surgery, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, 646000, China.
Department of Orthopedics, The Second People's Hospital of Chengdu, Chengdu, 610021, People's Republic of China.
出版信息
J Orthop Surg Res. 2023 Jan 22;18(1):59. doi: 10.1186/s13018-023-03511-3.
BACKGROUND
The purpose of the current study was to investigate the incidence of postoperative medical complications and 3-month mortality in patients ≥ 70 years old with hip fracture following hip arthroplasty (HA) and independent risk factors associated with postoperative medical complications and 3-month mortality during the Coronavirus Disease 2019 (COVID-19) pandemic.
METHODS
A multicenter retrospective study was conducted, patients ≥ 70 years old with HA for hip fracture under general anesthesia were included during COVID-19 and before COVID-19 pandemic. The outcome was defined as postoperative medical complications and 3-month mortality. The baseline characteristics and risk factors were collected, multivariable logistic regression was used to identify independent risk factors for postoperative medical complications and 3-month mortality.
RESULTS
A total of 1096 patients were included during COVID-19 pandemic and 1149 were included before COVID-19 pandemic in the study. Patients ≥ 70 years with hip fracture for HA had longer fracture to operation duration (7.10 ± 3.52 vs. 5.31 ± 1.29, P < 0.001), and the incidence of postoperative medical complications (21.90% vs. 12.53%, P < 0.001) and 3-month mortality (5.20% vs. 3.22%, P = 0.025) was higher during COVID-2019 pandemic. Multivariate logistic regression analysis showed that dementia (OR 2.73; 95% CI 1.37-5.44; P = 0.004), chronic obstructive pulmonary disease (COPD) (OR 3.00; 95% CI 1.92-4.71; P < 0.001), longer fracture to operation duration (OR 1.24; 95% CI 1.19-1.30; P < 0.001) were associated with increased risk for postoperative medical complications. COPD (OR 2.10; 95% CI 1.05-4.17; P = 0.035), dementia (OR 3.00; 95% CI 1.11-7.94; P = 0.031), postoperative medical complications (OR 4.99; 95% CI 2.68-9.28; P < 0.001), longer fracture to operation duration (OR 1.11; 95% CI 1.04-1.19; P = 0.002) were associated with increased risk for 3-month mortality.
CONCLUSIONS
In conclusion, we found that postoperative medical morbidity and 3-month mortality in patients with hip fracture underwent HA were 21.90% and 5.20%, respectively, during the COVID-19. COPD, dementia and longer fracture to operation duration were associated with negative outcome in patients with hip fracture underwent HA during the COVID-19.
背景
本研究的目的是探讨在 COVID-19 大流行期间和之前，行髋关节置换术（HA）治疗髋部骨折的≥70 岁老年患者术后发生医疗并发症和 3 个月死亡率的情况，以及与术后医疗并发症和 3 个月死亡率相关的独立危险因素。
方法
进行了一项多中心回顾性研究，纳入了在 COVID-19 大流行期间和之前行全身麻醉下 HA 治疗髋部骨折的≥70 岁老年患者。主要结局定义为术后医疗并发症和 3 个月死亡率。收集基线特征和危险因素，多变量逻辑回归用于确定术后医疗并发症和 3 个月死亡率的独立危险因素。
结果
COVID-19 大流行期间共纳入 1096 例患者，COVID-19 大流行前纳入 1149 例患者。≥70 岁的髋部骨折行 HA 的患者手术时间延长（7.10±3.52 比 5.31±1.29，P<0.001），术后医疗并发症发生率（21.90%比 12.53%，P<0.001）和 3 个月死亡率（5.20%比 3.22%，P=0.025）更高。多变量逻辑回归分析显示，痴呆（OR 2.73；95%CI 1.37-5.44；P=0.004）、慢性阻塞性肺疾病（COPD）（OR 3.00；95%CI 1.92-4.71；P<0.001）、手术时间延长（OR 1.24；95%CI 1.19-1.30；P<0.001）与术后医疗并发症风险增加相关。COPD（OR 2.10；95%CI 1.05-4.17；P=0.035）、痴呆（OR 3.00；95%CI 1.11-7.94；P=0.031）、术后医疗并发症（OR 4.99；95%CI 2.68-9.28；P<0.001）、手术时间延长（OR 1.11；95%CI 1.04-1.19；P=0.002）与 3 个月死亡率增加相关。
结论
总之，我们发现 COVID-19 期间，行髋关节置换术的髋部骨折患者术后医疗发病率和 3 个月死亡率分别为 21.90%和 5.20%。COPD、痴呆和手术时间延长与 COVID-19 期间行髋关节置换术的髋部骨折患者的不良结局相关。
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