老年患者下肢骨折术后2年内死亡的预测因素分析

Predictive factors of death within 2 years after following lower extremity fracture surgery in elderly patients

目的探讨行下肢骨折手术的老年患者术后2年内死亡的预测因素。方法收集择期行下肢骨折手术的老年患者(年龄≥65岁)的临床资料,根据术后2年内的生存状况,将患者分为生存组和死亡组。对两组间差异有统计学意义的因素进行多因素Cox回归分析,筛选出2年内死亡的预测因素,再通过受试者工作特征曲线(receiver operation characteristic,ROC)及曲线下面积(area under the curve,AUC)评估其预测能力。结果最终纳入372例患者资料进行统计分析,其中2年内死亡55例(病死率为14.7%)。Cox回归分析结果显示,年龄≥75岁(HR:2.155,95%CI:1.093~4.247)、美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级≥3级(HR:2.978,95%CI:1.242~7.183)、Charlson合并症指数(Charlson Comorbidity Index,CCI)评分≥2(HR:4.649,95%CI:2.467~8.761)、术前贫血(HR:2.050,95%CI:1.066~3.943)及术后住院期间发生心脑血管事件(HR:3.026,95%CI:1.491~6.140)为该类患者术后2年内死亡的预测因素,其AUC分别为0.677、0.733、0.700、0.584和0.658。上述5种因素联合预测的AUC为0.858,显著高于任意单一因素;ASA分级≥3级的预测敏感度最高(敏感度87.3%);CCI评分≥2的预测特异度最强(特异度92.7%)。结论老年患者行下肢骨折手术后2年内死亡的预测因素为年龄≥75岁、ASA分级≥3级、CCI评分≥2、术前贫血和术后住院期间发生心脑血管事件,且5种因素联合预测具有更高的预测价值,提示有针对性的进行围术期干预可能有助于提高患者长期生存率。

Objective To investigate the predictive factors of death within 2 years after lower extremity fracture surgery in elderly patients.Methods Clinical data were collected from patients aged≥65 years who underwent elective lower extremity fracture surgery.According to the survival status after operation within 2 years,patients were assigned into survival group and death group.Multivariate Cox regression analysis was performed on the factors with statistically difference between the two groups and predictive factors of death within 2 years were screened out.Receiver operation characteristic(ROC)curves and calculation of area under the ROC curve(AUC)were used to assess the predictive ability of the above factors.Results The data of 372 patients were eventually included for statistical analysis.Among them,55 deaths occurred within 2 years and the overall mortality was 14.7%.Cox regression analysis revealed that age≥75 years(HR:2.155,95%CI:1.093-4.247),American Society of Anesthesiologists(ASA)grade≥3(HR:2.978,95%CI:1.242-7.183),Charlson Comorbidity Index(CCI)score≥2(HR:4.649,95%CI:2.467-8.761),preoperative anemia(HR:2.050,95%CI:1.066-3.943),cardiocerebral vascular events during postoperative hospital stay(HR:3.026,95%CI:1.491-6.140)were the predictive factors of death within two years after operation.The AUC was 0.677,0.733,0.700,0.584 and 0.658,respectively.The AUC of the combination of the above five predictive factors was 0.858,which was significantly higher than the AUC of each factor alone.ASA grade≥3 was the most sensitive with a sensitivity of 87.3%and CCI≥2 was the most specific with a specificity of 92.7%.Conclusion Age≥75 years,ASA grade≥3,CCI score≥2,preoperative anemia and postoperative cardiocerebral vascular events can be predictive factors of death within 2 years after following lower extremity fracture surgery in elderly patients.The combined use of these five predictive factors was superior for death prediction than each factor alone.It is suggested that targeted perioperative intervention may help improve long-term quality of life of elderly patients.