老年髋部骨折患者术后30天内死亡风险及危险因素分析

Mortality and risk factors for hip fractures in elderly patients within 30 days of surgery

目的探索老年髋部骨折患者术后30 d内死亡率及相关危险因素。方法回顾性分析2012年1月至2016年12月我院收治的老年髋部骨折患者资料;根据手术后30 d内是否存活分为死亡组和存活组,分析比较两组患者年龄、性别、并存病、手术时机、固定方式的差异;单因素分析筛选后将有统计学差异的参数引入多因素Logistic回归分析中,筛选出术后30 d内患者死亡的独立危险因素。结果共收治老年髋部骨折患者1350例,符合入选标准1004例,术后30 d内死亡43例(4.28%);单因素分析结果显示死亡组患者平均年龄大,白细胞计数高,血红蛋白、白蛋白水平低,合并心律失常、肺部感染、心功能不全以及并存病数量≥4个的比率较高;多因素Logistic回归分析发现合并心律失常(OR=2.36,P=0.038)、肺部感染(OR=2.50,P=0.020)、心功能不全(OR=3.15,P=0.016)、白细胞计数高(OR=1.14,P=0.006)、白蛋白水平低(OR=1.08,P=0.037)是术后患者30 d内死亡的独立危险因素。结论老年髋部骨折患者术后30 d内病死率高,心律失常、肺部感染、心功能不全、白细胞计数高、白蛋白水平较低是死亡的独立危险因素。

Objective To investigate the mortality and related risk factors for hip fractures in elderly patients within 30 days of surgery.Methods Clinical data of elderly hip fracture patients in our hospital from January 2012 to December 2016 were retrospectively analyzed.Based on whether they survived within 30 days of surgery,patients were divided into the death group and the survival group.Differences in age,gender,comorbidities,timing of operation and fixation mode between the two groups were compared.Univariate analysis was conducted to detect significant factors,and Logistic regression analysis were performed to identify independent risk factors for 30-day mortality after operation.Results A total of 1350 elderly hip fracture patients were treated in our hospital,and 1004 cases met the inclusion criteria.Forty-three cases(4.28%)died within 30 days of operation.Univariate analysis showed that,compared with the survival group,the death group had a higher average age,a higher white blood cell count,lower hemoglobin and albumin levels,higher proportions of patients with arrhythmia,more pulmonary infections,higher cardiac insufficiency and more people with≥4 comorbidities.Multivariate Logistic analysis showed that arrhythmia(OR=2.36,P=0.038),pulmonary infection(OR=2.50,P=0.020),cardiac insufficiency(OR=3.15,P=0.016),high white blood cell count(OR=1.14,P=0.006),and low albumin(OR=1.08,P=0.037)were independent risk factors for increased mortality within 30 days of operation.Conclusions The 30-day mortality rate is high in elderly hip fracture patients.Arrhythmia,pulmonary infection,cardiac insufficiency,high white blood cell count,and low albumin level are independent risk factors for mortality in elderly hip fracture patients.