Department of Orthopaedic Surgery, Northwestern University, Chicago, Illinois, USA.
Orthop Surg. 2024 Jul;16(7):1665-1672. doi: 10.1111/os.14124. Epub 2024 Jun 4.
Distal femur fractures remain a significant cause of morbidity and mortality for elderly patients. There is a lack of large population studies investigating short-term outcomes after distal femur c in elderly patients. The purpose of this study is to assess the incidence of and risk factors for various short-term outcomes after distal femur open reduction internal fixation (ORIF) in the geriatric population.
The American College of Surgeons' National Surgical Quality Improvement Program (NSQIP) database was used to identify all primary distal femur ORIF cases in patients 60+ years old between January 1, 2015 and December 31, 2020 using Current Procedural Terminology (CPT) codes 27511, 27513, and 27514. Demographic, medical, and surgical variables were extracted for all patients. Propensity score matching was used to match cases in the two age groups based on various demographic and medical comorbidity variables. Several 30-day outcome measures were compared between the 60-79-year-old and 80+-year-old groups both before and after matching. Subsequent multivariate logistic regression was used to identify independent risk factors for 30-day outcome measures in the matched cohort.
A total of 2913 patients were included in the final cohort: 1711 patients in the 60-79-year-old group and 1202 patients in the 80+-year-old group. Most patients were female (n = 2385; 81.9%). Prior to matching, the older group had a higher incidence of 30-day mortality (1.9% vs. 6.2%), readmission (3.7% vs. 9.7%, p = 0.024), and non-home discharge (74.3% vs. 89.5%, p < 0.001). Additionally, the older group had a higher rate of blood loss requiring transfusion (30.9% vs. 42.3%, p < 0.001) and medical complications (10.4% vs. 16.4%, p < 0.001), including myocardial infarction (0.7% vs. 2.7%, p < 0.001), pneumonia (2.7% vs. 4.6%, p = 0.008), and urinary tract infection (4.1% vs. 6.1%, p = 0.0188). After matching, the older group consistently had a higher incidence of mortality, non-home-discharge, blood loss requiring transfusion, and myocardial infarction. Various independent risk factors were identified for 30-day morbidity and mortality, including American Society of Anesthesiologists (ASA) classification, body mass index (BMI) status, operative duration, and certain medical comorbidities.
Geriatric patients undergoing distal femur ORIF are at significant risk for 30-day morbidity and mortality. After matching, octogenarians and older patients specifically are at increased risk for mortality, non-home discharge, and surgical complications compared to patients aged 60-79 years old. Multiple factors, such as BMI status, ASA classification, operative time, and certain medical comorbidities, are independently associated with poor 30-day outcomes.
股骨远端骨折仍然是老年患者发病率和死亡率的重要原因。缺乏大型人群研究调查老年患者股骨远端骨折内固定术后的短期结果。本研究的目的是评估老年人群股骨远端切开复位内固定术（ORIF）后各种短期结果的发生率和危险因素。
使用美国外科医师学会国家手术质量改进计划（NSQIP）数据库，使用当前程序术语（CPT）代码 27511、27513 和 27514 确定 2015 年 1 月 1 日至 2020 年 12 月 31 日期间 60 岁以上患者的所有原发性股骨远端 ORIF 病例。提取所有患者的人口统计学、医学和手术变量。根据各种人口统计学和合并症变量，使用倾向评分匹配将两个年龄组中的病例进行匹配。在匹配之前和之后，比较了 60-79 岁组和 80+岁组之间的 30 天结果测量值。随后使用多变量逻辑回归确定匹配队列中 30 天结果测量值的独立危险因素。
共有 2913 名患者纳入最终队列：60-79 岁组 1711 名，80+岁组 1202 名。大多数患者为女性（n=2385；81.9%）。在匹配之前，老年组的 30 天死亡率（1.9%对 6.2%，p=0.024）、再入院率（3.7%对 9.7%，p=0.024）和非家庭出院率（74.3%对 89.5%，p<0.001）较高。此外，老年组的失血量需要输血（30.9%对 42.3%，p<0.001）和医疗并发症（10.4%对 16.4%，p<0.001）发生率较高，包括心肌梗死（0.7%对 2.7%，p<0.001）、肺炎（2.7%对 4.6%，p=0.008）和尿路感染（4.1%对 6.1%，p=0.0188）。匹配后，老年组的死亡率、非家庭出院率、需要输血和心肌梗死的发生率始终较高。确定了与 30 天发病率和死亡率相关的各种独立危险因素，包括美国麻醉师学会（ASA）分类、体重指数（BMI）状态、手术时间和某些合并症。
接受股骨远端 ORIF 的老年患者发生 30 天发病率和死亡率的风险很高。匹配后，与 60-79 岁的患者相比，80 岁以上的患者，特别是 80 岁以上的患者，死亡率、非家庭出院率和手术并发症的风险增加。BMI 状态、ASA 分级、手术时间和某些合并症等多种因素与不良 30 天结局独立相关。
