Bogallo J M, Castillejo C, Ramirez A, Cano J R, Rivas-Ruiz F, Guerado E
Department of Orthopedic Surgery and Traumatology, Hospital Universitario Costa del Sol, University of Malaga, Marbella, Málaga, Spain.
Department of Orthopedic Surgery and Traumatology, Hospital Universitario Costa del Sol, University of Malaga, Marbella, Málaga, Spain.
Rev Esp Cir Ortop Traumatol. 2024 Oct 22. doi: 10.1016/j.recot.2024.10.009.
This study aimed to analyze factors of comorbidity in older patients with acetabular fracture to know the role of disease in the treatment of this population.
Design: retrospective cohort study.
Single Level 2 Trauma Center.
A prospective database of acetabular fractures in patients over 55 years between January 2011 and January 2021 was studied. The exclusion criteria were age, pathological fracture, associated pelvic or hip fracture, follow-up of less than one year, and not having a computed tomography.
Patients were categorised as low (0-2), intermediate (3-4) or high (≥5) risk according to the age-adjusted Charlson comorbidity index (ACCI). The primary outcomes were risk of complications, number of complications and mortality at one year according to the ACCI scale. The difference between the pre-fracture Clinical Frailty Scale (CFS) and the one-year follow-up was also analysed. Descriptive and multivariable regression analyses were performed and ROC curves were constructed.
A total of 119 patients with acetabular fracture were collected. Ninety-eight out of those met inclusion criteria for our study. In regard to ACCI groups, 22% were low-risk, 26% were intermediate-risk, and 52% were high-risk. Statistically significant differences were found according to age, sex, mechanism of injury, treatment type, surgical treatment type, Clinical Frailty Scale (CFS) score, readmissions, complications, and mortality. ROC curves showed an association between ACCI and CFS in terms of complications and mortality, with the exception of unadjusted Charlson comorbidity index. On the multivariable regression analysis, associations were found between ACCI and presence of complications (OR 1.37, 95% CI 1.06-1.77, p=0.015) and mortality (OR 1.32, 95% CI 1.04-1.67, p=0.025) and between CFS and complications (OR 2.01, 95% CI 1.30-3.11, p=0.001) and mortality (OR 1.59, 95% CI 1.08-2.35, p=0.019). No statistical correlation was established between ASA and complications or mortality.
Presurgical ACCI and CFS scales may serve as a risk assessment method in treatment decision-making for patients with acetabular fracture. An association is observed between patients with a pre-fracture ACCI score ≥5 (high-risk) and a pre-fracture CFS score >4 (mild frailty) and mortality and complications at one year.
本研究旨在分析老年髋臼骨折患者的合并症因素，以了解疾病在该人群治疗中的作用。
设计：回顾性队列研究。
单一二级创伤中心。
研究了2011年1月至2021年1月期间55岁以上髋臼骨折患者的前瞻性数据库。排除标准为年龄、病理性骨折、合并骨盆或髋部骨折、随访时间少于一年以及未进行计算机断层扫描。
根据年龄调整的Charlson合并症指数（ACCI）将患者分为低风险（0 - 2）、中度风险（3 - 4）或高风险（≥5）。主要结局为根据ACCI量表得出的并发症风险、并发症数量和一年时的死亡率。还分析了骨折前临床衰弱量表（CFS）与一年随访之间的差异。进行了描述性和多变量回归分析，并构建了ROC曲线。
共收集了119例髋臼骨折患者。其中98例符合我们研究的纳入标准。在ACCI组中，22%为低风险，26%为中度风险，52%为高风险。在年龄、性别、损伤机制、治疗类型、手术治疗类型、临床衰弱量表（CFS）评分、再入院、并发症和死亡率方面发现了统计学上的显著差异。ROC曲线显示，除未调整的Charlson合并症指数外，ACCI与CFS在并发症和死亡率方面存在关联。在多变量回归分析中，发现ACCI与并发症的存在（OR 1.37，95%CI 1.06 - 1.77，p = 0.015）和死亡率（OR 1.32，95%CI 1.04 - 1.67，p = 0.025）以及CFS与并发症（OR 2.01，95%CI 1.30 - 3.11，p = 0.001）和死亡率（OR 1.59，95%CI 1.08 - 2.35，p = 0.019）之间存在关联。未发现ASA与并发症或死亡率之间存在统计学相关性。
术前ACCI和CFS量表可作为髋臼骨折患者治疗决策中的风险评估方法。观察到骨折前ACCI评分≥5（高风险）且骨折前CFS评分>4（轻度衰弱）的患者与一年时的死亡率和并发症之间存在关联。
