Paul Kavitha, Benedict Ameya Elizabeth, Sarkar Sweta, Mathews Robin R, Unnithan Ashwin
Acute Medicine, Ashford and St Peter's Hospitals NHS Foundation Trust, Chertsey, GBR.
Intensive Care Unit, Ashford and St Peter's Hospitals NHS Foundation Trust, Chertsey, GBR.
Cureus. 2024 Nov 15;16(11):e73788. doi: 10.7759/cureus.73788. eCollection 2024 Nov.
Introduction Neck-of-femur (NOF) fractures have high prevalence rates and require prompt surgical intervention for better outcomes. Perioperative hypotension (POH) in the geriatric population has poor outcomes with several contributing factors. The study intends to explore these risk factors and their correlation with patient outcomes. Methodology We studied a total of 276 patients who underwent surgical fixation of the NOF fracture at St Peter's Hospital, Surrey, from June 1, 2022, to June 1, 2023. Patients with POH were identified; the risk factors and one-year outcome were studied to obtain the results. We used odds ratio (OR), relative risk (RR), and multivariate regression to analyse the statistical association within the data. Results The incidence of POH was 68% (188/276) which included preoperative hypotension (9.78%), intraoperative hypotension (48.55%), and postoperative hypotension with a mean arterial pressure (MAP) of <65 mmHg (24.63%) and fall of systolic blood pressure to less than 80% (34.42%). Statistically significant risk factors were hypertension (OR: 1.330), heart disease (OR: 2.768), and hemoglobin (Hg) drop (OR: 1.42). The outcomes we studied were all statistically significant, with an RR of more than one. It includes postoperative delirium (RR: 2.037), postoperative 30-day morbidity (RR: 4.008), postoperative 30-day mortality (RR: 6.12), 365-day mortality (RR: 2.224), postoperative delay in mobilisation (RR: 1.329), and prolonged length of stay (RR: 1.273). Conclusion The study shows a clear association between POH and increased postoperative complications, highlighting the need for prompt intervention. This case-control study identified hypertension, history of heart disease, and perioperative blood loss as significant risk factors for developing POH. Also, this study demonstrates that POH is significantly associated with adverse outcomes, including the increased risk of delirium, prolonged hospital stays, and elevated 30-day morbidity in elderly patients undergoing hip fracture surgery. The findings also indicated that the duration of hypotension did not directly influence the outcomes; its occurrence alone is a significant factor in developing these complications.
引言
股骨颈骨折发病率高，需要及时进行手术干预以获得更好的治疗效果。老年患者围手术期低血压（POH）的治疗效果不佳，有多种促成因素。本研究旨在探讨这些风险因素及其与患者治疗效果的相关性。
方法
我们对2022年6月1日至2023年6月1日期间在萨里郡圣彼得医院接受股骨颈骨折手术固定的276例患者进行了研究。确定了发生POH的患者；研究了风险因素和一年期治疗效果以得出结果。我们使用优势比（OR）、相对风险（RR）和多变量回归分析数据中的统计关联。
结果
POH的发生率为68%（188/276），其中包括术前低血压（9.78%）、术中低血压（48.55%）以及术后平均动脉压（MAP）<65 mmHg的低血压（24.63%）和收缩压下降至低于80%的低血压（34.42%）。具有统计学意义的风险因素为高血压（OR：1.330）、心脏病（OR：2.768）和血红蛋白（Hg）下降（OR：1.42）。我们研究的治疗效果均具有统计学意义，RR均大于1。包括术后谵妄（RR：2.037）、术后30天发病率（RR：4.008）、术后30天死亡率（RR：6.12）、365天死亡率（RR：2.224）、术后活动延迟（RR：1.329）和住院时间延长（RR：1.273）。
结论
该研究表明POH与术后并发症增加之间存在明显关联，突出了及时干预的必要性。这项病例对照研究确定高血压、心脏病史和围手术期失血是发生POH的重要风险因素。此外，本研究表明POH与不良治疗效果显著相关，包括老年髋部骨折手术患者谵妄风险增加、住院时间延长和30天发病率升高。研究结果还表明，低血压持续时间并未直接影响治疗效果；低血压的发生本身就是发生这些并发症的一个重要因素。
