Boston Medical Center, One Boston Medical Center Pl, Boston University School of Medicine, , Boston, MA, 02118, USA.
Rawalpindi Medical University, Rawalpindi, 46000, Punjab, Pakistan.
BMC Cardiovasc Disord. 2023 Nov 3;23(1):535. doi: 10.1186/s12872-023-03584-2.
Hip fractures frequently necessitate hospitalization, especially among patients aged 75 and above who might concurrently suffer from aortic stenosis (AS). This study focuses on postoperative outcomes, potential determinants of morbidity and mortality, as well as evolving trends in patients with AS undergoing surgical repair of hip fractures.
A retrospective analysis of the Nationwide Inpatient Sample from 2008 to 2019 was conducted. Hip fracture cases were identified, and a subgroup with AS was isolated using the ICD-9 and ICD-10 diagnostic codes. We compared baseline characteristics, postoperative in-hospital outcomes and trends in mortality and morbidity between patients with and without AS.
From the dataset, 2,834,919 patients with hip fracture were identified on weighted analysis. Of these, 94,270 (3.3%) were found to have concurrent AS. The AS cohort was characterized by higher mean age and elevated burden of cardiovascular comorbidities, such as coronary artery disease, peripheral vascular disease, pulmonary hypertension, congestive heart failure and cardiac arrhythmias. Postoperative mortality following hip fracture surgery was greater in the AS groups compared to non-AS group (3.3% vs 1.57%, p < 0.001). Risk factors such as congestive heart failure (OR, 2.3[CI, 2.1-2.6]), age above 85 years (OR, 3.2[CI, 2.2-4.7]), cardiac arrhythmias (OR, 2.4[CI, 2.2-2.6]), end-stage renal disease (OR, 3.4[CI, 2.7-4.1]), malnutrition (OR, 2.3[CI, 2.1-2.7]) and AS (OR, 1.2[CI, 1.08-1.5] were associated with increased adjusted odds of postoperative mortality. AS was linked to higher adjusted odds of postoperative mortality (OR, 1.2 [CI, 1.1-1.5]) and complications such as acute myocardial infarction (OR, 1.2 [CI, 1.01-1.4]), cardiogenic shock (OR, 2.0[CI, 1.4-2.9]) and acute renal failure (OR, 1.1[CI, 1.02-1.2]). While hospital stay duration was comparable in both groups (average 5 days), the AS group incurred higher costs (mean $50,673 vs $44,607). The presence of acute heart failure in patients with AS and hip fracture significantly increased mortality, hospital stay, and cost. A notable decline in postoperative in-hospital mortality was observed in both groups from 2008-2019 though the rate of major in-hospital complications rose.
AS significantly influences postoperative in-hospital mortality and complication rates in hip fracture patients. While a reduction in postoperative mortality was observed in both AS and non-AS cohorts, the incidence of major in-hospital complications increased across both groups.
髋部骨折通常需要住院治疗，尤其是 75 岁及以上同时患有主动脉瓣狭窄（AS）的患者。本研究关注的是手术后的结果、发病率和死亡率的潜在决定因素，以及接受髋关节骨折手术修复的 AS 患者的发展趋势。
对 2008 年至 2019 年全国住院患者样本进行回顾性分析。确定髋部骨折病例，并使用 ICD-9 和 ICD-10 诊断代码分离出同时患有 AS 的亚组。我们比较了有和没有 AS 的患者的基线特征、术后住院期间的结局以及死亡率和发病率的趋势。
在加权分析中，从数据集确定了 2834919 例髋部骨折患者。其中，94270（3.3%）例患者同时患有 AS。AS 组的平均年龄较高，心血管合并症的负担较重，如冠状动脉疾病、外周血管疾病、肺动脉高压、充血性心力衰竭和心律失常。与非 AS 组相比，AS 组髋关节骨折手术后的死亡率更高（3.3%比 1.57%，p<0.001）。心力衰竭（OR，2.3[CI，2.1-2.6]）、年龄大于 85 岁（OR，3.2[CI，2.2-4.7]）、心律失常（OR，2.4[CI，2.2-2.6]）、终末期肾病（OR，3.4[CI，2.7-4.1]）、营养不良（OR，2.3[CI，2.1-2.7]）和 AS（OR，1.2[CI，1.08-1.5]）等风险因素与术后死亡率的调整后比值比增加相关。AS 与调整后的术后死亡率（OR，1.2[CI，1.1-1.5]）和并发症（如急性心肌梗死[OR，1.2[CI，1.01-1.4]）、心源性休克（OR，2.0[CI，1.4-2.9]）和急性肾衰竭（OR，1.1[CI，1.02-1.2]）的调整后比值比增加有关。虽然两组的住院时间（平均 5 天）相似，但 AS 组的费用更高（平均 50673 美元对 44607 美元）。AS 患者合并急性心力衰竭显著增加了死亡率、住院时间和费用。尽管两组的主要院内并发症发生率均有所上升，但 2008 年至 2019 年期间，两组的术后院内死亡率均显著下降。
AS 显著影响髋部骨折患者的术后院内死亡率和并发症发生率。尽管 AS 和非 AS 两组的术后死亡率均有所下降，但两组的主要院内并发症发生率均有所上升。
