Geriatric Distal Femur Fractures Treated With Distal Femoral Replacement Are Associated With Higher Rates of Readmissions and Complications.
Geriatric Distal Femur Fractures Treated With Distal Femoral Replacement Are Associated With Higher Rates of Readmissions and Complications.
复制标题
采用远端股骨置换术治疗的老年股骨远端骨折与较高的再入院率和并发症相关。
DOI：
10.1097/bot.0000000000002638
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发表时间：
2023
影响因子：
2.3
通讯作者：
Haller,JustinM
中科院分区：
文献类型：
--
作者：
Dekeyser,GrahamJ;Martin,BrookI;Marchand,LucasS;Rothberg,DavidL;Higgins,ThomasF;Haller,JustinM
目的：比较接受手术固定与股骨远端置换（DFR）的老年患者股骨远端骨折修复的死亡率和并发症。设计：回顾性比较。设置：医疗保险受益人。患者/参与者：使用2016年至2019年医疗保险和医疗补助服务中心数据确定的65岁及以上股骨远端骨折患者。干预：手术固定主要结果测量：死亡率、再入院率、围手术期并发症和90天的费用使用Mahalanobis最近邻匹配进行比较，以解释年龄、性别、种族和Charlson Comorbid指数的差异。结果：大多数患者（90%，28，251/31，380）接受了手术固定。固定组患者年龄明显偏大（81.1岁vs. 80.4岁，P< 0.001），开放性骨折较多（1.6% vs. 0.5%，P< 0.001）。90天（差异：1.2%[-0.5%至3%]，P= 0.16）、6个月（差异：0.6%[-1.5%至2.7%]，P= 0.59）和1年死亡率（差异：-3.3%[-2.9至2.3]，P= 0.80）无差异。DFR的90天（差异：5.4%[2.8%-8.1%]，P< 0.001）、6个月（差异：6.5%[3.1%-9.9%]，P< 0.001）和1年再入院率（差异：5.5%[2.2-8.7]，P= 0.001）更高。术后1年内，DFR组感染、肺栓塞、深静脉血栓形成和器械相关并发症的发生率显著较高。DFR（$57，894）明显比手术固定（$46，016; P<0.001.Conclusions：老年股骨远端骨折患者1年死亡率为22.5%。DFR与显著更大的感染、器械相关并发症、肺栓塞、深静脉血栓形成、成本以及术后90天、6个月和1年内的再入院相关。证据等级：治疗级III。有关证据等级的完整描述，请参见作者说明。
Objective:Compare mortality and complications of distal femur fracture repair among elderly patients who receive operative fixation versus distal femur replacement (DFR).Design:Retrospective comparison.Setting:Medicare beneficiaries.Patients/Participants:Patients 65 years of age and older with distal femur fracture identified using Center for Medicare & Medicaid Services data from 2016 to 2019.Intervention:Operative fixation (open reduction with plating or intramedullary nail) or DFR.Main Outcome Measurements:Mortality, readmissions, perioperative complications, and 90-day cost were compared between groups using Mahalanobis nearest-neighbor matching to account for differences in age, sex, race, and the Charlson Comorbidity Index.Results:Most patients (90%, 28,251/31,380) received operative fixation. Patients in the fixation group were significantly older (81.1 vs. 80.4 years, P< 0.001), and there were more an open fractures (1.6% vs. 0.5%, P< 0.001). There were no differences in 90-day (difference: 1.2%[− 0.5% to 3%], P= 0.16), 6-month (difference: 0.6%[− 1.5% to 2.7%], P= 0.59), and 1-year mortality (difference:− 3.3%[− 2.9 to 2.3], P= 0.80). DFR had greater 90-day (difference: 5.4%[2.8%–8.1%], P< 0.001), 6-month (difference: 6.5%[3.1%–9.9%], P< 0.001), and 1-year readmission (difference: 5.5%[2.2–8.7], P= 0.001). DFR had significantly greater rates of infection, pulmonary embolism, deep vein thrombosis, and device-related complication within 1 year from surgery. DFR ($57,894) was significantly more expensive than operative fixation ($46,016; P< 0.001) during the total 90-day episode.Conclusions:Elderly patients with distal femur fracture have a 22.5% 1-year mortality rate. DFR was associated with significantly greater infection, device-related complication, pulmonary embolism, deep vein thrombosis, cost, and readmission within 90 days, 6 months, and 1 year of surgery.Level of Evidence:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.