Min Aoying, Zhao Wei, Li Wei, Li Weining, Hou Zhiyong, Wang Zhiqian
Department of Geriatric Orthopedics, The Third Hospital of Hebei MedicalUniversity, No.139 ZiQiang Lu, Shijiazhuang, Hebei, 050051, PR China.
Department of Nursing, The Third Hospital of Hebei Medical University, No.139, ZiQiang Lu, Shijiazhuang, Hebei, 050051, PR China.
BMC Musculoskelet Disord. 2025 Jan 2;26(1):6. doi: 10.1186/s12891-024-08252-w.
Patients with preoperative acute heart failure (AHF) after hip fracture in the elderly have a worse prognosis. We aim to investigate the characteristics, risk factors and postoperative complications of elderly patients with hip fracture complicated with preoperative AHF. We also looked at the effect of the severity of anemia at admission on the prognosis of the above people.
A retrospective study of hip fracture patients (aged ≥ 65) admitted to the Department of Geriatric Orthopaedics, Third Hospital, Hebei Medical University, was conducted from January 2018 to October 2020. We used univariate and multivariate logistic regression to assess risk factors for preoperative AHF. The Kaplan-Meier survival curve shows the relationship between the severity of anemia on admission and all-cause mortality in elderly hip fracture patients with preoperative AHF.
Out of the 1092 patients, 503 had preoperative AHF and the incidence of it in hip fracture patients was 46.1%. Age, coronary artery disease, chronic atrial fibrillation, Age-Adjusted Charlson Comorbidity Index (ACCI), admission anemia, admission albumin < 40 g/dl, and admission C-reactive protein (CRP) were all significantly different between those with AHF and those without. Multivariate logistic regression analysis revealed that age ≥ 80 years (OR 1.740, 95% CI 1.309-2.313), coronary artery disease (OR 1.417, 95% CI 1.017-1.975), chronic atrial fibrillation (OR 4.010, 95% CI 1.757-9.152), admission anemia (OR 1.433, 95% CI 1.051-1.953) are the independent risk factors for preoperative AHF in elderly patients with hip fracture (p < 0.05). The HF group exhibited a higher incidence of postoperative complications, such as anemia, arrhythmia, NOAF (new-onset atrial fibrillation), AIS (acute ischemic stroke), electrolyte disturbance and hypoproteinemia. The moderate-to-severe anemia group had a higher incidence of postoperative complications, including deep vein thrombosis of the lower limbs, NOAF, and hypoproteinemia, as well as all-cause mortality.
Older patients combined with admission anemia, coronary artery disease, chronic atrial fibrillation are more likely to have preoperative AHF after hip fracture. For such patients, early and effective identification and strengthening perioperative management can avoid the occurrence of adverse events. For patients with moderate and severe anemia at admission, timely intervention is recommended to reduce postoperative complications and mortality.
老年髋部骨折患者术前发生急性心力衰竭（AHF），预后较差。我们旨在研究老年髋部骨折合并术前AHF患者的特征、危险因素及术后并发症。我们还观察了入院时贫血严重程度对上述人群预后的影响。
对2018年1月至2020年10月在河北医科大学第三医院老年骨科住院的髋部骨折患者（年龄≥65岁）进行回顾性研究。我们采用单因素和多因素逻辑回归分析评估术前AHF的危险因素。Kaplan-Meier生存曲线显示了入院时贫血严重程度与术前AHF的老年髋部骨折患者全因死亡率之间的关系。
1092例患者中，503例有术前AHF，髋部骨折患者中其发生率为46.1%。AHF患者与无AHF患者在年龄、冠状动脉疾病、慢性心房颤动、年龄校正的Charlson合并症指数（ACCI）、入院时贫血、入院时白蛋白<40g/dl和入院时C反应蛋白（CRP）方面均有显著差异。多因素逻辑回归分析显示，年龄≥80岁（OR 1.740，95%CI 1.309-2.313）、冠状动脉疾病（OR 1.417，95%CI 1.017-1.975）、慢性心房颤动（OR 4.010，95%CI 1.757-9.152）、入院时贫血（OR 1.433，95%CI 1.051-1.953）是老年髋部骨折患者术前AHF的独立危险因素（p<0.05）。HF组术后并发症发生率较高，如贫血、心律失常、新发心房颤动（NOAF）、急性缺血性卒中（AIS）、电解质紊乱和低蛋白血症。中重度贫血组术后并发症发生率较高，包括下肢深静脉血栓形成、NOAF和低蛋白血症，以及全因死亡率。
老年患者合并入院时贫血、冠状动脉疾病、慢性心房颤动，髋部骨折后更易发生术前AHF。对于此类患者，早期有效识别并加强围手术期管理可避免不良事件的发生。对于入院时中重度贫血患者，建议及时干预以降低术后并发症和死亡率。
