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老年股骨近端骨折手术后30天内再入院及住院死亡率的相关因素:回顾性队列研究

Factors Associated with Readmission within 30 Days after Discharge and In-Hospital Mortality after Proximal Femoral Fracture Surgery in the Elderly: Retrospective Cohort.

作者信息

Pinto Alex Fabiano Dias, Teatini Clarissa Moreira, Avelar Núbia Carelli Pereira de, Leopoldino Amanda Aparecida Oliveira, Moura Isabel Cristina Gomes

机构信息

Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, MG, Brasil.

Departamento de Ciências da Saúde, Universidade Federal de Santa Catarina. Araranguá, SC, Brasil.

出版信息

Rev Bras Ortop (Sao Paulo). 2023 May 25;58(2):222-230. doi: 10.1055/s-0043-1768624. eCollection 2023 Apr.

Abstract

To evaluate the factors associated with readmission within 30 days after discharge (R30) and in-hospital mortality (IHM) in elderly patients undergoing proximal femur fracture surgery (PFF).  Retrospective cohort with data from 896 medical records of elderly (≥ 60 years) patients submitted to PFF surgery in a Brazilian hospital between November 2014 and December, 2019. The patients included were followed-up from the date of hospitalization for surgery up to 30 days after discharge. As independent variables, we evaluated gender, age, marital status, pre- and postoperative hemoglobin (Hb), international normalized ratio, time of hospitalization related to the surgery, door-surgery time, comorbidities, previous surgeries, use of medications, and the American Society of Anesthesiologists (ASA) score. The incidence of R30 was 10.2% (95% confidence interval [CI]: 8.3-12.3%), and the incidence of IHM was 5.7% (95%CI: 4.3-7.4%). Regarding R30, hypertension (odds ratio [OR]: 1.71; 95%CI: 1.03-2.96), and regular use of psychotropic drugs (OR: 1.74; 95%CI: 1.12-2.72) were associated in the adjusted model. In the case of IHM, higher chances were associated with chronic kidney disease (CKD) (OR: 5.80; 95%CI: 2.64-12.31), longer hospitalization time (OR: 1.06; 95%CI: 1.01-1.10), and R30 (OR: 3.60; 95%CI: 1.54-7.96). Higher preoperative Hb values were associated with a lower chance of mortality (OR: 0.73; 95%CI: 0.61-0.87). Findings suggest that the occurrence of these outcomes is associated with comorbidities, medications, and Hb.

摘要

评估老年股骨近端骨折手术(PFF)患者出院后30天内再入院(R30)和住院死亡率(IHM)的相关因素。 采用回顾性队列研究,收集了2014年11月至2019年12月间巴西一家医院896例接受PFF手术的老年(≥60岁)患者的医疗记录数据。纳入的患者从住院手术之日起随访至出院后30天。作为自变量,我们评估了性别、年龄、婚姻状况、术前和术后血红蛋白(Hb)、国际标准化比值、与手术相关的住院时间、门-手术时间、合并症、既往手术、药物使用情况以及美国麻醉医师协会(ASA)评分。R30的发生率为10.2%(95%置信区间[CI]:8.3-12.3%),IHM的发生率为5.7%(95%CI:4.3-7.4%)。关于R30,在调整模型中,高血压(比值比[OR]:1.71;95%CI:1.03-2.96)和经常使用精神药物(OR:1.74;95%CI:1.12-2.72)与之相关。对于IHM,更高的发生几率与慢性肾脏病(CKD)(OR:5.80;95%CI:2.64-12.31)、更长的住院时间(OR:1.06;95%CI:1.01-1.10)以及R30(OR:3.60;95%CI:1.54-7.96)相关。术前较高的Hb值与较低的死亡几率相关(OR:0.73;95%CI:0.61-0.87)。研究结果表明,这些结局的发生与合并症、药物使用和Hb有关。

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