老年人髋部骨折术后1年内死亡的危险因素研究

Risk Factors for 1-year Mortality in Elderly Patients after Hip Fracture Surgery

目的调查老年人髋部骨折术后1年内的死亡率,并探讨其相关危险因素。方法选取2014—2015年于首都医科大学宣武医院住院治疗的一侧髋部(包括股骨颈及股骨粗隆间)骨折老年患者285例为研究对象。通过查阅病历收集患者一般资料(包括年龄、性别、身高、体质量、居住地、收入水平、婚姻状况、文化程度、医疗保险模式),住院相关资料[包括住院天数、术前合并内科疾病、入院时血红蛋白水平、入院时清蛋白水平、受伤到手术时间、手术时长、美国麻醉医师协会(ASA)分级、住院期间肺部感染情况],计算体质指数(BMI)。于术后1年通过电话随访、门诊复查或社区协助访视收集术后亲属照护情况、抗骨质疏松治疗、康复训练情况,对于死亡者记录其死亡时间和死亡原因。比较不同特征老年人髋部骨折术后1年内死亡率,采用Cox回归分析老年人髋部骨折术后1年内死亡的危险因素。结果不同年龄、收入水平、婚姻状况、文化程度、医疗保险模式、术前合并内科疾病的数量、合并冠心病情况、入院时血红蛋白水平、入院时清蛋白水平、术前ASA分级、住院期间肺部感染情况、有无亲属照护、术后抗骨质疏松治疗、康复训练情况的老年人髋部骨折术后1年内死亡率的比较,差异有统计学意义(P<0.05)。Cox回归分析结果显示,无亲属照护、术后未接受抗骨质疏松治疗是髋部骨折术后1年内死亡的危险因素(P<0.05)。结论无亲属照护、未进行抗骨质疏松治疗是老年人髋部骨折术后1年内死亡的危险因素。

Objective To investigate the 1-year mortality in elderly patients after hip fracture surgery and its associated risk factors.Methods The enrolled participants were 285 elderly patients receiving inpatient treatment for unilateral hip fracture(including femoral neck and intertrochanteric fracture)during 2014-2015 from Xuanwu Hospital Capital Medical University.By reviewing the medical records,we collected their sociodemographic data(age,gender,height,weight,current residential address,income,marital status,education level,medical fee reimbursement pattern),and data about inpatient treatment(length of stay,preoperative medical comorbidities,baseline hemoglobin and albumin levels,duration between timing of the hip fracture and surgery,duration of surgery,ASA physical status classification,in-hospital pulmonary infection),bady mass index was calculated with height and weight.Using telephone-based interview,outpatient review,or community-aided interview,we collected the information about postoperative care by relatives,anti-osteoporosis treatment,rehabilitation training,community-aided interview of them,and also collected the timing and causes of death of the deceased within one year after the surgery.Univariate and Cox regression analyses were used to explore the factors associated with 1-year mortality after surgery.Results The 1-year postoperative mortality in the elderly patients with hip fracture differed significantly by age,income,marital status,educational level,medical fee reimbursement pattern,number of preoperative medical comorbidities,prevalence of coronary heart disease,baseline hemoglobin and albumin levels,preoperative ASA physical status classification,prevalences of in-hospital pulmonary infection,care by relatives,anti-osteoporosis treatment and rehabilitation training(P<0.05).Cox regression analysis showed that lack of postoperative care by relatives and anti-osteoporosis treatment were risk factors for mortality within 1 year after surgery(P<0.05).Conclusion Lack of postoperative care by relatives and anti-osteoporosis treatment were the main risk factors for 1-year mortality in elderly patients after hip fracture surgery.