退伍军人健康管理局17868名男性老年髋部骨折后的中位生存期。
Median survival following geriatric hip fracture among 17,868 males from the Veterans Health Administration.
作者信息
Lee Alexander, Xi Ianto Lin, Ahn Jaimo, Bernstein Joseph
机构信息
Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, United States.
Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, United States.
出版信息
Front Surg. 2023 Mar 22;10:1090680. doi: 10.3389/fsurg.2023.1090680. eCollection 2023.
BACKGROUND
The expected value of treatments for geriatric femoral neck fracture is influenced by the predicted duration of survival after injury. Specifically, total hip arthroplasty is more suited for patients likely to live long enough to reap its longer-term benefits. For predicting short- and medium-term survival, there are many tools available, but for longer-term survival prognosis the current literature is insufficient. Our hypothesis is that patient age at the time of injury correlates with median life expectancy and survival rates, and these values can anchor a prediction regarding a given patient's life expectancy. We therefore sought to determine median and fractional survival rates at 30 days, and 1, 2, 5 and 10 years after surgery for a large cohort of elderly patients with hip fracture as a function of age.
METHODS
17,868 male patients, 65-89 years of age, treated surgically for hip fracture within the Veterans Affairs system were assessed. From this set, 10,000 patients were randomly selected, and their ages at surgery and death (if any) were recorded at least 10 years post-operatively. Median and fractional survival rates were recorded at 1 month and 1, 2, 5, and 10 years. The mathematical relationship between age and median survival was determined. All findings from the 10,000-patient cohort were compared to corresponding values of the remaining 7,868 patients, to assess the predictive power of the initial observations.
RESULTS
The median survival rate for the entire cohort was 2.2 years, with 90.4% of the group surviving at 30 days. The percentage of the cohort surviving at 1, 2, 5 and 10 years after treatment was 64.5%, 52.3%, 27.1% and 8.9% respectively. Median survival was approximately (13 - (0.13 × ) years for patients of all ages.
CONCLUSIONS
Median survival after geriatric hip fracture can be accurately predicted by the patient's age at the time of injury. Median survival and fractional survival at key milestones can help estimate life-expectancy and thereby help guide treatment.
背景
老年股骨颈骨折治疗的预期价值受损伤后预测生存时间的影响。具体而言，全髋关节置换术更适合那些有可能存活足够长时间以获得其长期益处的患者。对于预测短期和中期生存，有许多可用工具，但对于长期生存预后，目前的文献并不充分。我们的假设是，受伤时的患者年龄与中位预期寿命和生存率相关，并且这些值可以作为对特定患者预期寿命预测的依据。因此，我们试图确定一大群老年髋部骨折患者术后30天以及1、2、5和10年的中位和分数生存率与年龄的函数关系。
方法
对退伍军人事务系统内接受手术治疗的17868名65 - 89岁男性髋部骨折患者进行评估。从这组患者中随机选取10000名患者，并记录他们的手术年龄和死亡年龄（如果有），记录时间至少为术后10年。记录1个月以及1、2、5和10年时的中位和分数生存率。确定年龄与中位生存之间的数学关系。将10000名患者队列的所有结果与其余7868名患者的相应值进行比较，以评估初始观察结果的预测能力。
结果
整个队列的中位生存率为2.2年，90.4%的患者在30天时存活。治疗后1、2、5和10年存活的队列百分比分别为64.5%、52.3%、27.1%和8.9%。所有年龄患者的中位生存约为（13 - （0.13×年龄））年。
结论
老年髋部骨折后的中位生存可以通过受伤时患者的年龄准确预测。关键时间点的中位生存和分数生存有助于估计预期寿命，从而有助于指导治疗。
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