Li Xuejun, Wan Meixuan, Zhang Shuaihao, He Yuanming, Qiu Daojing, Wang Xiaowei, Liu Zhi, Chen Xiaobin, Xi Chunhua
Department of Orthopedics, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
J Orthop Surg Res. 2025 Aug 12;20(1):764. doi: 10.1186/s13018-025-06175-3.
Postoperative cardiac events (PCEs) are life threatening in older patients undergoing hip fracture surgery. This study aimed to investigate the risk factors for PCEs in these patients and to evaluate the impact of PCEs on all-cause mortality after surgery.
A retrospective review was performed of consecutive patients who underwent surgery for hip fractures at the Seventh Medical Center, Chinese PLA General Hospital, from January 2012 to December 2020. The patients were divided into a PCE group and a non-PCE group according to whether they experienced PCEs. Univariate and multivariate logistic regression analyses were employed to investigate the independent risk factors for PCEs. Kaplan‒Meier curves and log-rank tests were used to compare the cumulative mortality between the two groups, and a Cox proportional hazards regression model was used to estimate risk factors for mortality.
We recruited 1718 patients, 169 of whom (9.8%) had experienced PCEs. Acute heart failure (66.9%, 113/169) was the most common PCE, followed by major arrhythmia (18.9%, 32/169) and acute coronary syndrome (14.2%, 24/169). Age ≥ 80 years (OR = 1.92, 95% CI = 1.29-2.91), male sex (OR = 1.55, 95% CI = 1.09-2.20), a history of arrhythmia (OR = 1.65, 95% CI = 1.07-2.48), preoperative deep vein thrombosis (DVT) (OR = 1.89, 95% CI = 1.00-3.43), a higher CCI score (OR = 2.12, 95% CI = 1.43-3.10) and an ASA classification of III or IV (OR = 1.80, 95% CI = 1.23-2.67) were independent risk factors for PCEs. Patients with PCEs had increased cumulative mortality within 1 year (P < 0.001), and PCEs were associated with 30-day mortality (adjusted HR = 2.05, 95% CI = 1.09-3.65).
PCEs are not uncommon after hip fracture surgery, and may affect mortality in the early postoperative period. Patients with advanced age, male sex, a history of arrhythmia, preoperative DVT, and a higher CCI score and ASA classification are more likely to develop PCEs. Strengthening perioperative care should be considered to avoid potential PCEs in patients with the above risk factors.
术后心脏事件（PCEs）对于接受髋部骨折手术的老年患者来说危及生命。本研究旨在调查这些患者发生PCEs的危险因素，并评估PCEs对术后全因死亡率的影响。
对2012年1月至2020年12月在中国人民解放军总医院第七医学中心接受髋部骨折手术的连续患者进行回顾性研究。根据患者是否经历PCEs，将其分为PCE组和非PCE组。采用单因素和多因素逻辑回归分析来研究PCEs的独立危险因素。采用Kaplan-Meier曲线和对数秩检验比较两组之间的累积死亡率，并使用Cox比例风险回归模型估计死亡率的危险因素。
我们招募了1718例患者，其中169例（9.8%）经历了PCEs。急性心力衰竭（66.9%，113/169）是最常见的PCE，其次是严重心律失常（18.9%，32/169）和急性冠状动脉综合征（14.2%，24/169）。年龄≥80岁（OR = 1.92，95%CI = 1.29 - 2.91）、男性（OR = 1.55，95%CI = 1.09 - 2.20）、心律失常病史（OR = 1.65，95%CI = 1.07 - 2.48）、术前深静脉血栓形成（DVT）（OR = 1.89，95%CI = 1.00 - 3.43）、较高的CCI评分（OR = 2.12，95%CI = 1.43 - 3.10）和ASA分级为III或IV（OR = 1.80，95%CI = 1.23 - 2.67）是PCEs的独立危险因素。发生PCEs的患者1年内累积死亡率增加（P < 0.001），且PCEs与30天死亡率相关（调整后HR = 2.05，95%CI = 1.09 - 3.
