Outcome after surgery for the treatment of hip fracture in the extremely elderly
Outcome after surgery for the treatment of hip fracture in the extremely elderly
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DOI：
10.2106/jbjs.g.00883
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发表时间：
2008-09-01
影响因子：
5.3
通讯作者：
Gregori, A.
中科院分区：
文献类型：
--
作者：
Holt, G.;Smith, R.;Gregori, A.
背景资料：由于人口结构的变化，极端老年人是西方社会增长最快的群体之一。以前的研究与高龄增加死亡率后髋部骨折，然而，这一发现并不一致，方法：苏格兰髋部骨折审计是一个前瞻性的，全国性的，多中心的研究，收集数据的年龄超过50岁的病人谁是入院髋部骨折。在本研究中，我们使用了1998年1月至2005年12月期间从22个骨科急诊室收集的数据。极老年队列由919名年龄在95岁或以上的人组成。将病例组合变量和结果与15，461名年龄在75至89岁之间的个体的模式控制组进行比较。结果指标包括30天和120天的死亡率、住院时间、居住地和活动能力。多变量Logistic回归模型被用来比较组间的结果，同时控制显着的病例组合variables.Results：极老年人提出了较差的健康状况指标，表现出较高的美国麻醉医师协会的分数。此外，这一组在骨折时独立移动的可能性较小，而在机构护理中的可能性较大（p < 0.001）。即使在调整病例组合变量后，极高龄患者30天和120天的死亡率也较高。极端老年人也不太可能返回家园或返回到以前的水平mobility.Conclusions：虽然极端老年人表现出较高的患病率prefracture指标的不良结果，这些病例组合变量的统计控制显示进一步年龄相关的恶化后的生存和手术治疗髋部骨折的结果。
Background: As a consequence of changes in population demographics, the extremely elderly represent one of the fastest growing groups in Western society. Previous studies have associated advanced age with increased mortality after hip fracture; however, this finding has not been consistent.Methods: The Scottish Hip Fracture Audit is a prospective, national, multicenter study that collects data on patients over the age of fifty years who are admitted to the hospital with a hip fracture. For the present study, we used data collected from twenty two acute-care orthopaedic units between January 1998 and December 2005. The extremely elderly cohort consisted of 919 individuals with an age of ninety-five years or more. Case-mix variables and outcomes were compared with those for a modal control group of 15,461 individuals who were seventy-five to eighty-nine years of age. Outcome measures included thirty and 120-day mortality rates, the length of the hospital stay, the place of residence, and mobility. A multivariable logistic regression model was used to compare outcomes between groups while controlling for significant case-mix variables.Results: The extremely elderly presented with poorer indicators of health status as demonstrated by higher American Society of Anesthesiologists scores. In addition, this group was less likely to be independently mobile and more likely to be in institutional care at the time of the fracture (p < 0.001). Mortality at thirty and 120 days was higher in the extremely elderly even after adjusting for case-mix variables. The extremely elderly also were less likely to return home or to return to previous levels of mobility.Conclusions: Although the extremely elderly exhibited a higher prevalence of prefracture indicators of poor outcome, statistical control for these case-mix variables showed further age-related deterioration in survival and outcomes after surgery for the treatment of a hip fracture.