Gao Yucheng, Zhou Shaoyang, Gao Wang, Zhang Yuanwei, Shi Liu, Xie Tian, Tian Chuwei, Chen Hui, Rui Yunfeng
Department of Orthopedics, Zhongda Hospital Affiliated to Southeast University, Nanjing, China.
Orthopaedic Trauma Institute, Zhongda Hospital Affiliated to Southeast University, Nanjing, China.
Geriatr Orthop Surg Rehabil. 2025 Jun 25;16:21514593251356135. doi: 10.1177/21514593251356135. eCollection 2025.
Elderly patients have an impaired functional state and multiple comorbidities, resulting in poor postoperative rehabilitation ability and high rates of disability and mortality. However, little evidence exists on mortality predictors for geriatric hip fractures within the context of the multidisciplinary team co-management model. This study aimed to investigate the incidence and explore preoperative indicators of 1-year mortality following hip fractures in the elderly under this model.
A total of 439 elderly patients (130 men and 309 women) surgically treated for hip fractures under the multidisciplinary team co-management model between January 2018 and June 2021were included. Data regarding demographics, health state-related variables, injury- and admission-related variables, and preoperative laboratory test results were collected from medical records. Univariate and multivariate logistic regression analyses were used to identify preoperative indicators for 1-year mortality.
A total of 49 patients died within 1 year of hip fracture surgery between January 2018 and June 2021, with an accumulated mortality rate of 11.16%. In univariate analysis, 14 items were found to be significant. In the multivariable logistic regression model, age >85 years, body mass index <21.0 kg/m, time from injury to admission >9.5 h, preoperative haemoglobin <117 g/L, serum albumin <33.9 g/L, lactate dehydrogenase >292 U/L, and blood urea nitrogen >8.5 mmol/L were the independent preoperative indicators for 1-year mortality after surgery in elderly patients with hip fracture under the multidisciplinary team co-management model.
This study establishes a novel set of preoperative predictors for 1-year mortality in geriatric hip fracture patients managed under an MDT model, distinct from previous investigations focusing on postoperative interventions. The identified indicators enable early risk stratification, facilitating timely preoperative optimization. These findings underscore the prognostic value of integrating clinical and biochemical markers before surgery, warranting validation in multicenter prospective studies. Further prospective studies should be conducted to elucidate these associations and assess the effectiveness of targeted measures.
老年患者功能状态受损且合并多种疾病，导致术后康复能力差，残疾率和死亡率高。然而，在多学科团队共同管理模式下，关于老年髋部骨折死亡率预测因素的证据很少。本研究旨在调查多学科团队共同管理模式下老年髋部骨折患者1年死亡率的发生率，并探索术前指标。
纳入2018年1月至2021年6月期间在多学科团队共同管理模式下接受手术治疗的439例老年髋部骨折患者（130例男性和309例女性）。从病历中收集有关人口统计学、健康状况相关变量、损伤和入院相关变量以及术前实验室检查结果的数据。采用单因素和多因素逻辑回归分析确定1年死亡率的术前指标。
2018年1月至2021年6月期间，共有49例患者在髋部骨折手术后1年内死亡，累积死亡率为11.16%。单因素分析发现14项指标具有统计学意义。在多变量逻辑回归模型中，年龄>85岁、体重指数<21.0kg/m、受伤至入院时间>9.5小时、术前血红蛋白<117g/L、血清白蛋白<33.9g/L、乳酸脱氢酶>292U/L和血尿素氮>8.5mmol/L是多学科团队共同管理模式下老年髋部骨折患者术后1年死亡率的独立术前指标。
本研究建立了一套新的多学科团队（MDT）模式下老年髋部骨折患者1年死亡率的术前预测指标，与以往侧重于术后干预的研究不同。所确定的指标能够实现早期风险分层，便于及时进行术前优化。这些发现强调了术前整合临床和生化标志物的预后价值，需要在多中心前瞻性研究中进行验证。应进行进一步的前瞻性研究以阐明这些关联并评估针对性措施的有效性。
