Department of Geriatric Orthopedics, The Third Hospital of Hebei Medical University, No.139 ZiQiang Lu, Shijiazhuang, 050051, Hebei PR, China.
Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, No.139, ZiQiang Lu, Shijiazhuang, 050051, Hebei PR, China.
BMC Musculoskelet Disord. 2024 Feb 15;25(1):143. doi: 10.1186/s12891-024-07255-x.
Elderly patients with hip fracture who develop perioperative acute heart failure (AHF) have a poor prognosis. The aim of the present study is to investigate the potential risks of AHF in elderly hip-fracture patients in the postoperative period and to evaluate the prognostic significance of AHF.
A retrospective analysis was conducted on hip fracture patients at the Third Hospital of Hebei Medical University, who were continuously in hospital from September 2018 to August 2020. To identify independent risk factors for AHF in elderly patients with hip fracture, univariate and multivariate Logistic regression analysis was employed. The Kaplan-Meier survival curve illustrated the relationship between all-cause mortality in the AHF and non-AHF groups. An assessment of the correlation between baseline factors and all-cause mortality was conducted by means of univariable and multivariable Cox proportional hazards analysis.
We eventually recruited 492 patients,318 of whom were in the AHF group. Statistical significance was found between the two groups for age group, concomitant coronary heart disease, COPD, haemoglobin level below 100 g/L on admission, albumin level below 40 g/L on admission, and increased intraoperative blood loss. Age over 75, concomitant coronary artery disease, hemoglobin level below 100 g/L and albumin level below 40 g/L on admission were independent risk factors for AHF in older hip fracture patients. The AHF group exhibited a higher incidence of perioperative complications, such as anemia, cardiovascular issues, and stress hyperglycemia, as well as all-cause mortality. Based on our COX regression analysis, we have identified that the main risk factors for all-cause mortality in AHF patients are concomitant coronary heart disease, absence of pulmonary infection, absence of diabetes, absence of cancer, and absence of urinary tract infection.
Enhancing hip fracture prevention for AHF is particularly important. It is crucial to make informed decisions to avoid poor prognoses. Patients whose age over 75 years old, concomitant coronary heart disease, hemoglobin < 100 g/L and album< 40 g/L on admission are more likely to develop perioperative AHF. To avert complications and potential fatalities, patients with AHF must receive appropriate care during the perioperative period.
老年髋部骨折患者围手术期发生急性心力衰竭（AHF）预后较差。本研究旨在探讨老年髋部骨折患者术后发生 AHF 的潜在风险，并评估 AHF 的预后意义。
回顾性分析 2018 年 9 月至 2020 年 8 月在河北医科大学第三医院连续住院的髋部骨折患者。采用单因素和多因素 Logistic 回归分析确定老年髋部骨折患者发生 AHF 的独立危险因素。Kaplan-Meier 生存曲线描绘了 AHF 组和非 AHF 组全因死亡率之间的关系。采用单因素和多因素 Cox 比例风险分析评估基线因素与全因死亡率的相关性。
共纳入 492 例患者，其中 318 例为 AHF 组。两组在年龄组、合并冠心病、COPD、入院时血红蛋白<100g/L、白蛋白<40g/L、术中出血量增加等方面存在统计学差异。年龄>75 岁、合并冠心病、入院时血红蛋白<100g/L 和白蛋白<40g/L 是老年髋部骨折患者发生 AHF 的独立危险因素。AHF 组围手术期并发症发生率较高，如贫血、心血管问题、应激性高血糖等，全因死亡率也较高。根据 COX 回归分析，我们发现 AHF 患者全因死亡的主要危险因素是合并冠心病、无肺部感染、无糖尿病、无癌症、无尿路感染。
加强对 AHF 的髋部骨折预防尤为重要。做出明智的决策以避免不良预后至关重要。年龄>75 岁、合并冠心病、血红蛋白<100g/L 和白蛋白<40g/L 的患者更有可能在围手术期发生 AHF。为避免并发症和潜在死亡，围手术期 AHF 患者必须接受适当的护理。
