Department of Cardiology, Ashford and St Peter's NHS Foundation Trust, Guildford Road, Chertsey, KT16 0PZ, Surrey, UK.
Department of Orthopaedic Trauma, Ashford and St Peter's NHS Foundation Trust, Guildford Road, Chertsey, KT16 0PZ, Surrey, UK.
Intern Emerg Med. 2023 Aug;18(5):1561-1568. doi: 10.1007/s11739-023-03264-1. Epub 2023 Apr 26.
Amongst hip fracture admissions, mortality is higher in men than in women. However, sex differences in other care-quality measures have not been well-documented. We aimed to examine sex differences in mortality as well as a wide range of underlying health indicators and clinical outcomes in adults ≥ 60 year of age admitted with hip fractures from their own homes to a single NHS hospital between April-2009 and June-2019. Sex differences in delirium, length of stay (LOS) and mortality in hospital, readmission, and discharge destination, were examined by logistic regression. There were 787 women and 318 men of similar mean age (± SD): 83.1 year (± 8.6) and 82.5 year (± 9.0), respectively (P = 0.269). There were no sex differences in history of dementia or diabetes, anticholinergic burden, pre-fracture physical function, American Society of Anesthesiologists grades, or surgical and medical management. Stroke and ischaemic heart disease, polypharmacy, and alcohol consumption were more common in men. After adjustment for these differences and age, men had greater risk of delirium (with or without cognitive impairment) within one day of surgery: OR = 1.75 (95%CI 1.14-2.68), LOS ≥ 3 weeks in hospital: OR = 1.52 (1.07-2.16), mortality in hospital: OR = 2.04 (1.14-3.64), and readmission once or more after 30 days of a discharge: OR = 1.53 (1.03-2.31). Men had a lower risk of a new discharge to residential/nursing care: OR = 0.46 (0.23-0.93). The present study revealed that, in addition to a greater risk of mortality than women, men also had many other adverse health outcomes. These findings, which have not been well-documented, serve to stimulate future targeted preventive strategies and research.
在髋部骨折患者中，男性的死亡率高于女性。然而，关于其他护理质量指标的性别差异尚未得到充分记录。我们旨在研究年龄在 60 岁及以上的成年人因髋部骨折从家中入院至单一 NHS 医院的死亡率以及广泛的基础健康指标和临床结局的性别差异，这些患者入院时间为 2009 年 4 月至 2019 年 6 月。使用逻辑回归分析了谵妄、住院时间 (LOS) 以及死亡率、再入院率和出院去向的性别差异。女性和男性的平均年龄（±标准差）分别为 83.1 岁（±8.6）和 82.5 岁（±9.0）（P=0.269）。两组患者在痴呆或糖尿病、抗胆碱能药物负担、骨折前身体功能、美国麻醉医师协会分级或手术和医疗管理方面均无差异。男性更常见的是中风和缺血性心脏病、多种药物治疗和饮酒。在调整这些差异和年龄后，男性在手术 1 天内发生谵妄（伴或不伴认知障碍）的风险更高：比值比（OR）=1.75（95%置信区间 1.14-2.68）、住院 LOS≥3 周的风险：OR=1.52（1.07-2.16）、住院死亡率：OR=2.04（1.14-3.64）、出院后 30 天内再入院 1 次或多次的风险：OR=1.53（1.03-2.31）。男性更有可能出院后转往住宅/护理院：OR=0.46（0.23-0.93）。本研究表明，男性除了死亡率高于女性外，还有许多其他不良健康结局。这些发现尚未得到充分记录，有助于激发未来有针对性的预防策略和研究。
