Tohidi Mina, Grammatopoulos George, Mann Stephen M, Pysklywec Alexandra, Groome Patti A
Department of Surgery, Queen's University, Kingston, Ontario, Canada.
The Ottawa Hospital, Ottawa, Ontario, Canada.
J Bone Joint Surg Am. 2024 Nov 20;106(22):2073-2084. doi: 10.2106/JBJS.24.00379. Epub 2024 Sep 18.
The aim of this study was to describe long-term (10-year) patient survival after arthroplasty for hip fracture and to determine what patient factors are associated with that outcome.
We performed a retrospective cohort analysis of patients ≥60 years old who underwent either hemiarthroplasty or total hip arthroplasty for femoral neck fracture between 2002 and 2009. We used routinely collected, validated health-care databases linked through ICES (formerly known as the Institute for Clinical Evaluative Sciences). We estimated the association between baseline variables and survival 10 years post-fracture using Poisson regression. Restricted cubic spline functions modeled the probability of 10-year survival by age and tested whether there was an inflection point after which the probability of 10-year survival decreased more rapidly. We estimated 10-year survival probabilities for different patient groups.
There were 19,659 patients in the final cohort. Eighteen percent (3,564) of the patients were alive at 10 years postoperatively. Factors associated with a higher likelihood of 10-year survival included younger age, female sex (risk ratio [RR] = 1.56, 95% confidence interval [CI] = 1.46 to 1.68), lower American Society of Anesthesiologists (ASA) class (ASA I or II versus IV or V: RR = 1.96, 95% CI = 1.76 to 2.19), independent living status (RR = 2.68, 95% CI = 2.23 to 3.22), and fewer specific comorbidities. A threshold age of 73 years was the inflection point after which the probability of 10-year survival decreased more rapidly in females. Estimated 10-year survival probabilities ranged from 79.0% (95% CI = 75.5% to 82.5%) to 0.8% (95% CI = 0.6% to 1.0%).
Approximately 1 in 6 patients live at least 10 years following a hip fracture. This study identifies baseline characteristics that predict survival greater than 10 years, including an age of <75 years, an ASA class of I or II, and independent living status prior to the hip fracture. Results can inform discussions around treatment choices, anticipated outcomes, and the natural history of hip fractures.
Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.
本研究的目的是描述髋部骨折关节置换术后的长期（10年）患者生存率，并确定哪些患者因素与该结果相关。
我们对2002年至2009年间因股骨颈骨折接受半髋关节置换术或全髋关节置换术的60岁及以上患者进行了回顾性队列分析。我们使用通过ICES（前身为临床评估科学研究所）链接的常规收集的、经过验证的医疗保健数据库。我们使用泊松回归估计基线变量与骨折后10年生存率之间的关联。受限立方样条函数通过年龄对10年生存概率进行建模，并测试是否存在一个拐点，在该拐点之后10年生存概率下降得更快。我们估计了不同患者组的10年生存概率。
最终队列中有19659名患者。18%（3564名）的患者术后10年仍存活。与10年生存率较高可能性相关的因素包括年龄较小、女性（风险比[RR]=1.56，95%置信区间[CI]=1.46至1.68）、较低的美国麻醉医师协会（ASA）分级（ASA I或II级与IV或V级相比：RR=1.96，95%CI=1.76至2.19）、独立生活状态（RR=2.68，95%CI=2.23至3.22）以及较少的特定合并症。73岁的阈值年龄是拐点，在该年龄之后，女性10年生存概率下降得更快。估计的10年生存概率范围从79.0%（95%CI=75.5%至82.5%）到0.8%（95%CI=0.6%至1.0%）。
大约六分之一的患者在髋部骨折后至少存活10年。本研究确定了预测生存超过10年的基线特征，包括年龄<75岁、ASA分级为I或II级以及髋部骨折前的独立生活状态。研究结果可为围绕治疗选择、预期结果和髋部骨折自然史的讨论提供参考。
预后III级。有关证据水平的完整描述，请参阅作者指南。
