Kalem Mahmut, Kocaoğlu Hakan, Duman Berker, Şahin Ercan, Yoğun Yener, Ovali Sancar A
Department of Orthopedics and Traumatology, Ankara University Faculty of Medicine, Ankara, Turkey.
Department of Psychiatry, Consultation-Liason Psychiatry, Ankara University Faculty of Medicine, Ankara, Turkey.
Geriatr Orthop Surg Rehabil. 2023 Aug 4;14:21514593231193234. doi: 10.1177/21514593231193234. eCollection 2023.
Fear of falling, anxiety, depression, and pain levels are important risk factors for poor functional outcomes that may potentially be modifiable. We aimed to examine prospective associations between those factors following surgery for intertrochanteric hip fracture.
This study is a prospective observational cohort study of patients aged over 65 diagnosed with isolated intertrochanteric hip fracture. Three hundred and seventy patients who underwent intramedullary fixation surgery were screened; 188 cases were included in our final evaluation. Patients with any concomitant fracture, major psychiatric/neurocognitive and neurological disorders and those with any other major disease were excluded from the study. Age, Charlson Comorbidity Index (CCI), Geriatric Depression Scale (GDS), State-Trait Anxiety Inventory (STAI), Falls Efficacy Scale International (FES-I), and Visual Analog Scale (VAS) scores on the day of surgery (baseline) were evaluated as predictors of poor/good outcome at 90 days after surgery, by Harris Hip Score (HHS) with a cut-off score of 70.
HHS score was significantly predicted at baseline by the full model [χ (7) = 18.18, = .01]. However, only STAI-state scores were significantly added to the model [Exp (B) 95% CI: .92 (.86-.99)].
In this prospective cohort study, we found that higher levels of anxiety state on the day of surgery predicts a poor outcome at 90 days following surgery. We did not find significant associations between other variables, including age, GDS, STAI-trait, FES-I, VAS, and CCI. This potentially modifiable psychological factor may inform surgeons and could be a potential mediator. Future prospective studies are needed to replicate these findings.
Prognostic level I.
害怕跌倒、焦虑、抑郁和疼痛程度是功能预后不良的重要风险因素，这些因素可能是可以改变的。我们旨在研究转子间髋部骨折手术后这些因素之间的前瞻性关联。
本研究是一项对65岁以上诊断为单纯转子间髋部骨折患者的前瞻性观察队列研究。对370例行髓内固定手术的患者进行筛选；最终纳入188例进行评估。排除有任何合并骨折、严重精神/神经认知和神经系统疾病以及任何其他重大疾病的患者。将手术当天（基线）的年龄、查尔森合并症指数（CCI）、老年抑郁量表（GDS）、状态-特质焦虑量表（STAI）、国际跌倒效能量表（FES-I）和视觉模拟量表（VAS）评分作为术后90天预后良好/不良的预测指标，采用Harris髋关节评分（HHS），临界值为70分。
完整模型在基线时显著预测了HHS评分[χ（7）= 18.18，P = 0.01]。然而，只有STAI状态评分显著加入模型[Exp（B）95% CI：0.92（0.86 - 0.99）]。
在这项前瞻性队列研究中，我们发现手术当天较高水平的焦虑状态预示着术后90天预后不良。我们未发现其他变量之间存在显著关联，包括年龄、GDS、STAI特质、FES-I、VAS和CCI。这个潜在可改变的心理因素可能为外科医生提供参考，并且可能是一个潜在的调节因素。需要未来的前瞻性研究来重复这些发现。
预后I级。
