Mau Makoa, Thorne Tyler, Rossbach Kai, Sato Eleanor H, Zhang Chong, Presson Angela P, Haller Justin M
Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, USA.
Division Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA.
Bone Jt Open. 2025 Jul 8;6(7):785-795. doi: 10.1302/2633-1462.67.BJO-2025-0059.R1.
The aim of this study was to analyze the risk of mortality and other postoperative complications following restricted weightbearing in geriatric patients who undergo fixation of a hip fracture, while accurately controlling for patient frailty.
The National Surgical Quality Improvement Program (NSQIP) database January 2016 to December 2020 was queried for operatively treated hip fractures in patients aged ≥ 60 years using Current Procedural Terminology (CPT) codes (n = 53,959). Logistic regressions and receiver operating characteristic (ROC) curve analysis were conducted to determine the frailty measure which best predicts 30-day mortality among American Society of Anesthesiologists grade (ASA), five-factor modified Fraility Index (mFI-5), and Risk Analysis Index Recalibrated Version (RAI-Rev). The effect of weightbearing on 30-day mortality, and severe (SAE) and minor (MAE) adverse events, was assessed using logistic regressions while controlling for the selected frailty measure and other relevant patient characteristics.
A total of 53,959 patients met the inclusion criteria, and 36,177 patients (67%) were weightbearing as tolerated postoperatively. Under ROC curve, the only discriminatory performance was by RAI-Rev in 30-day mortality. Controlling for RAI-Rev, age, sex, BMI, functional status, and CPT, weightbearing patients had a 42% lower odds of 30-day mortality (p < 0.001), a 31% lower odds of a SAE (p < 0.001), and a 24% lower odds of a MAE (p < 0.001) in comparison to non-weightbearing patients.
Geriatric hip fractures are prevalent in patients with varying degrees of health. RAI-Rev is a better predictor of postoperative mortality than ASA grade and mFI-5, and should be used in evaluating the risk of geriatric hip fractures. Postoperative weightbearing is associated with significant reductions in complications for geriatric hip fracture patients, even while controlling for frailty. Our findings suggest that postoperative weightbearing after surgical fixation of geriatric hip fractures should be encouraged for able patients.
本研究旨在分析老年髋部骨折内固定患者在限制负重情况下的死亡风险及其他术后并发症，同时准确控制患者的虚弱程度。
利用现行手术操作术语（CPT）编码，查询2016年1月至2020年12月国家外科质量改进计划（NSQIP）数据库中年龄≥60岁的接受手术治疗的髋部骨折患者（n = 53,959）。进行逻辑回归和受试者工作特征（ROC）曲线分析，以确定在美国麻醉医师协会分级（ASA）、五因素改良虚弱指数（mFI-5）和重新校准版风险分析指数（RAI-Rev）中，哪项虚弱指标最能预测30天死亡率。在控制所选虚弱指标和其他相关患者特征的同时，使用逻辑回归评估负重对30天死亡率以及严重（SAE）和轻微（MAE）不良事件的影响。
共有53,959例患者符合纳入标准，36,177例患者（67%）术后可耐受负重。在ROC曲线下，在30天死亡率方面，只有RAI-Rev具有鉴别性能。在控制RAI-Rev、年龄、性别、体重指数、功能状态和CPT的情况下，与非负重患者相比，负重患者30天死亡率的几率降低42%（p < 0.001），严重不良事件的几率降低31%（p < 0.001），轻微不良事件的几率降低24%（p < 0.001）。
老年髋部骨折在健康程度不同的患者中普遍存在。RAI-Rev比ASA分级和mFI-5更能预测术后死亡率，应将其用于评估老年髋部骨折的风险。即使在控制虚弱程度的情况下，术后负重也与老年髋部骨折患者并发症的显著减少相关。我们的研究结果表明，对于能够耐受的老年髋部骨折患者，手术固定后应鼓励术后负重。
