老年髋部骨折非手术治疗后的死亡率：一项匹配队列分析。

Mortality Rates After Nonoperative Geriatric Hip Fracture Treatment: A Matched Cohort Analysis.

作者信息

Shin Edward D, Sandhu Kevin P, Wiseley Benjamin R, Hetzel Scott J, Winzenried Alec E, Simske Natasha M, Johnson Kristina P, Goodspeed David C, Doro Christopher J, Whiting Paul S

机构信息

Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI.

The authors report no conflict of interest.

出版信息

J Orthop Trauma. 2023 May 1;37(5):237-242. doi: 10.1097/BOT.0000000000002549.

DOI:10.1097/BOT.0000000000002549

PMID:36728997

Abstract

OBJECTIVE

To compare the mortality rate between geriatric patients with hip fracture treated nonoperatively and a matched cohort treated operatively.

DESIGN

Retrospective Observational Matched Cohort Study.

SETTING

Academic Level 1 Trauma Center.

PATIENTS

Geriatric patients who sustained femoral neck and intertrochanteric/peritrochanteric fractures, excluding isolated greater trochanteric fractures. All patients older than 65 years with hip fractures over a 10-year period were identified. Operative patients were matched at a 2:1 ratio, when possible, to nonoperative patients based on Charlson Comorbidity Index and American Society of Anesthesiologists score.

INTERVENTION

Nonoperative treatment or operative treatment (femoral neck fractures: cannulated screw fixation or hemiarthroplasty; intertrochanteric/peritrochanteric fractures: sliding hip screw or cephalomedullary nail fixation; or proximal femoral locking plate).

MAIN OUTCOMES

Mortality calculated at 30 and 90 days, and 1-year after injury. Mortality was compared between groups using logistic regression while controlling for age, CVA/TIA, and dementia.

RESULTS

Seven hundred seventy-two patients (171 nonoperative and 601 operative) were initially identified. After applying the matching algorithm, 128 nonoperative and 239 operative patients were included in the analysis. There were no significant differences in age, sex, Charlson Comorbidity Index, or American Society of Anesthesiologists score between the cohorts. Nonoperative patients had a significantly higher 1-year mortality rate than operative patients [46.1% vs. 18.0%, Odds Ratio (95% confidence interval): 3.85 (2.34-6.41), P < 0.001].

CONCLUSIONS

Geriatric patients with hip fracture treated nonoperatively had a 1-year mortality rate of 46.1%, more than double the rate among operative patients.

LEVEL OF EVIDENCE

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

摘要

目的

比较老年髋部骨折非手术治疗患者与匹配的手术治疗队列患者的死亡率。

设计

回顾性观察性匹配队列研究。

地点

一级学术创伤中心。

患者

股骨颈及转子间/转子周围骨折的老年患者，不包括单纯大转子骨折。确定了所有65岁以上在10年期间发生髋部骨折的患者。手术患者尽可能按照2:1的比例根据查尔森合并症指数和美国麻醉医师协会评分与非手术患者进行匹配。

干预措施

非手术治疗或手术治疗（股骨颈骨折：空心钉内固定或半髋关节置换术；转子间/转子周围骨折：动力髋螺钉或髓内钉固定；或股骨近端锁定钢板）。

主要结局

计算伤后30天、90天和1年时的死亡率。使用逻辑回归比较两组之间的死亡率，同时控制年龄、脑血管意外/短暂性脑缺血发作和痴呆。

结果

最初确定了772例患者（171例非手术治疗和601例手术治疗）。应用匹配算法后，128例非手术治疗患者和239例手术治疗患者纳入分析。两组在年龄、性别、查尔森合并症指数或美国麻醉医师协会评分方面无显著差异。非手术治疗患者的1年死亡率显著高于手术治疗患者[46.1%对18.0%，优势比（95%置信区间）：3.85（2.34 - 6.41），P < 0.001]。