半髋关节置换术治疗老年股骨颈骨折时术前国际标准化比值与包括死亡率在内的术后结局之间的关联
The Association Between Preoperative International Normalized Ratio Values and Postoperative Outcomes including Mortality in Geriatric Femoral Neck Fractures Treated With Hemiarthroplasty.
作者信息
Uvodich Mason E, Dugdale Evan M, Duong Stephanie Q, Cancio-Bello Alexandra, Sems Stephen A, Yuan Brandon J
机构信息
Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN; and.
Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN.
出版信息
J Orthop Trauma. 2023 May 1;37(5):230-236. doi: 10.1097/BOT.0000000000002557.
OBJECTIVES
To evaluate the association between preoperative international normalized ratio (INR) and postoperative mortality and other outcomes after hemiarthroplasty for geriatric femoral neck fractures.
DESIGN
Retrospective cohort study.
SETTING
A single Level-I trauma center.
PATIENTS/PARTICIPANTS: Patients ≥55 years of age with OTA/AO 31B proximal femur fractures [1556 patients (1616 hips)].
INTERVENTION
Hip hemiarthroplasty.
MAIN OUTCOME MEASUREMENTS
Ninety-day mortality, postoperative transfusion within 72 hours, and 90-day postoperative outcomes.
RESULTS
Adjusting for confounders, the association of preoperative INR and 90-day mortality was not statistically significant [hazard ratio (HR): 1.3; 95% confidence interval (CI): 0.97, 1.8; P = 0.08]. Dementia (HR: 1.9; 95% CI: 1.4-2.6; P < 0.001), Charlson Comorbidity Index (HR: 1.1; 95% CI: 1.1-1.2; P < 0.001), and age by decade (HR: 1.4; 95% CI: 1.1-1.8; P = 0.002) were associated with 90-day mortality. Increasing INR was significantly associated with blood transfusion [odds ratio (OR) 1.4; 95% CI 1.03-1.6; P = 0.031]. Preoperative hemoglobin <10 g/dL (OR 13.7; 95% CI 8.4-23.3; P < 0.001) was also associated with a postoperative transfusion, whereas intraoperative tranexamic acid use (OR 0.3; 95% CI 0.2-0.5; P < 0.001) was inversely associated with postoperative transfusion rate. INR was associated with superficial wound infection (HR: 2.0; 95% CI: 1.1-3.7; P = 0.02) and noninfected wound complications (HR: 1.6; 95% CI: 1.1-2.4; P = 0.007). Risk of superficial infection increased when INR was >1.8.
CONCLUSION
When controlling for confounders, preoperative INR was not significantly associated with 90-day mortality. Underlying medical conditions contribute to postoperative mortality more than an elevated INR. However, INR is associated with superficial wound complications. This risk becomes statistically significant as INR rises above 1.8.
LEVEL OF EVIDENCE
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
目的
评估老年股骨颈骨折半髋关节置换术前国际标准化比值（INR）与术后死亡率及其他结局之间的关联。
设计
回顾性队列研究。
地点
一家一级创伤中心。
患者/参与者：年龄≥55岁、患有OTA/AO 31B型股骨近端骨折的患者[1556例患者（1616髋）]。
干预措施
髋关节半髋关节置换术。
主要观察指标
90天死亡率、术后72小时内输血情况以及术后90天结局。
结果
校正混杂因素后，术前INR与90天死亡率之间的关联无统计学意义[风险比（HR）：1.3；95%置信区间（CI）：0.97，1.8；P = 0.08]。痴呆（HR：1.9；95%CI：1.4 - 2.6；P < 0.001）、Charlson合并症指数（HR：1.1；95%CI：1.1 - 1.2；P < 0.001）以及每增加十岁的年龄（HR：1.4；95%CI：1.1 - 1.8；P = 0.002）与90天死亡率相关。INR升高与输血显著相关[比值比（OR）1.4；95%CI 1.03 - 1.6；P = 0.031]。术前血红蛋白<10 g/dL（OR 13.7；95%CI 8.4 - 23.3；P < 0.001）也与术后输血相关，而术中使用氨甲环酸（OR 0.3；95%CI
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