Surgery Department, Maasstad Hospital, Rotterdam, Zuid-Holland, the Netherlands.
Surgery Department, Franciscus Hospital, Rotterdam, Zuid-Holland, the Netherlands.
Clin Interv Aging. 2024 Mar 21;19:539-549. doi: 10.2147/CIA.S441280. eCollection 2024.
The primary objective of this study was to identify new risk factors and to confirm previously reported risk factors associated with 30-day mortality after hip fracture surgery.
A prospective hip fracture database was used to obtain data. In total, 3523 patients who underwent hip fracture surgery between 2011 and 2021 were included. Univariable and multivariable logistic regression was used to screen and identify candidate risk factors. Twenty-seven baseline factors and 16 peri-operative factors were included in the univariable analysis and 28 of those factors were included in multivariable analysis.
8.6% of the patients who underwent hip fracture surgery died within 30 days after surgery. Prognostic factors associated with 30-day mortality after hip fracture surgery were as follows: age 90-100 years (OR = 4.7, 95% CI: 1.07-19.98, p = 0.041) and above 100 years (OR = 11.3, 95% CI: 1.28-100.26, p = 0.029), male gender (OR = 2.6, 95% CI: 1.97-3.33, p < 0.001), American Society of Anesthesiologists (ASA) 3 and ASA 4 (OR = 2.1, 95% CI: 1.44-3.14, p < 0.001), medical history of dementia (OR = 1.7, 95% CI: 1.25-2.36, p = 0.001), decreased albumin level (OR = 0.94, 95% CI: 0.92-0.97, p < 0.001), decreased glomerular filtration rate (GFR) (OR = 0.98, 95% CI: 0.98-0.99, p < 0.001), residential status of nursing home (OR = 2.1, 95% CI: 1.44-2.87, p < 0.001), higher Katz Index of Independence in Activities of Daily Living (KATZ-ADL) score (OR = 1.1, 95% CI: 1.01-1.16, p=0.018) and postoperative pneumonia (OR = 2.4, 95% CI: 1.72-3.38, p < 0.001).
A high mortality rate in patients after acute hip fracture surgery is known. Factors that are associated with an increased mortality are age above 90 years, male gender, ASA 3 and ASA 4, medical history of dementia, decreased albumin, decreased GFR, residential status of nursing home, higher KATZ-ADL score and postoperative pneumonia.
本研究的主要目的是确定与髋部骨折手术后 30 天死亡率相关的新的风险因素，并确认先前报告的风险因素。
使用前瞻性髋部骨折数据库获取数据。共纳入 2011 年至 2021 年间接受髋部骨折手术的 3523 例患者。采用单变量和多变量逻辑回归筛选并确定候选风险因素。单变量分析中纳入了 27 项基线因素和 16 项围手术期因素，多变量分析中纳入了 28 项因素。
接受髋部骨折手术的患者中，8.6%在手术后 30 天内死亡。与髋部骨折手术后 30 天死亡率相关的预后因素如下：90-100 岁（OR=4.7，95%CI：1.07-19.98，p=0.041）和 100 岁以上（OR=11.3，95%CI：1.28-100.26，p=0.029）、男性（OR=2.6，95%CI：1.97-3.33，p<0.001）、美国麻醉医师学会（ASA）3 级和 4 级（OR=2.1，95%CI：1.44-3.14，p<0.001）、痴呆病史（OR=1.7，95%CI：1.25-2.36，p=0.001）、白蛋白水平降低（OR=0.94，95%CI：0.92-0.97，p<0.001）、肾小球滤过率（GFR）降低（OR=0.98，95%CI：0.98-0.99，p<0.001）、居住在养老院（OR=2.1，95%CI：1.44-2.87，p<0.001）、较高的 Katz 日常生活活动独立性量表（KATZ-ADL）评分（OR=1.1，95%CI：1.01-1.16，p=0.018）和术后肺炎（OR=2.4，95%CI：1.72-3.38，p<0.001）。
髋部骨折手术后患者的死亡率较高。与死亡率增加相关的因素包括年龄在 90 岁以上、男性、ASA 3 级和 4 级、痴呆病史、白蛋白降低、GFR 降低、居住在养老院、较高的 KATZ-ADL 评分和术后肺炎。
