Association between dementia and postoperative complications after hip fracture surgery in the elderly: analysis of 87,654 patients using a national administrative database
Association between dementia and postoperative complications after hip fracture surgery in the elderly: analysis of 87,654 patients using a national administrative database
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DOI：
10.1007/s00402-015-2321-8
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发表时间：
2015-11-01
影响因子：
2.3
通讯作者：
Tanaka, Sakae
中科院分区：
文献类型：
--
作者：
Tsuda, Yusuke;Yasunaga, Hideo;Tanaka, Sakae
髋部骨折手术后痴呆患者的死亡率高于无痴呆患者；然而，很少有大规模的研究调查这类患者的术后院内并发症。本研究的目的是通过一个大型的国家数据库来阐明伴有和不伴有痴呆的患者髋部骨折手术后发生的并发症。我们回顾性研究了年龄在千分之一到70岁之间的患者，他们接受了半关节置换术、股骨颈骨折植骨术或股骨粗隆间骨折植骨术，并比较了痴呆患者和非痴呆患者的术后并发症发生情况。进行多因素logistic回归分析以调整患者特征和医院因素。该研究共纳入87,654例患者，其中9419例患有痴呆症。与非痴呆组相比，痴呆组总体术后并发症发生率更高[比值比（OR） 1.45；p < 0.001)、手术部位感染（OR 1.58; p = 0.004）、尿路感染（OR 1.87; p < 0.001）和呼吸系统并发症（OR 1.49; p < 0.001）。所有类型髋部骨折手术的术后并发症发生率均较高。术后并发症的发生率明显高于yen80一千分之一岁的病人(或1.37;p < 0.001)和那些痴呆(或1.45;p < 0.001),任何类型的恶性肿瘤(或1.42,p < 0.001),心血管疾病史(或1.33;p < 0.001),脑血管疾病史(或1.15;p = 0.029),慢性肾功能衰竭(或1.36;p < 0.001),肝硬化(或1.41,p < 0.001)或输血手术后(或1.49,p < 0.001)。我们的研究结果强调需要特别注意手术部位感染、尿路感染和呼吸道并发症在髋部骨折术后患者术前痴呆。这些结果为这些患者的管理提供了额外的有用证据。
Mortality following hip fracture surgery is higher in patients with dementia than those without; however, few large-scale studies have investigated postoperative in-hospital complications in such patients. The aim of this study was to elucidate the complications that occur after hip fracture surgery in patients with and without dementia using a large national database.We retrospectively identified patients aged a parts per thousand yen70 years who underwent hemiarthroplasty, osteosynthesis for femoral neck fracture or osteosynthesis for intertrochanteric fracture, and compared the occurrence of postoperative complications between patients with and without dementia. Multivariate logistic regression analysis was performed to adjust for patient characteristics and hospital factors.A total of 87,654 patients were included in this study, including 9419 with dementia. Compared with the non-dementia group, the dementia group showed a higher incidence of overall postoperative complications [odds ratio (OR) 1.45; p < 0.001), surgical site infection (OR 1.58; p = 0.004), urinary tract infection (OR 1.87; p < 0.001) and respiratory complications (OR 1.49; p < 0.001). The rate of postoperative complications was higher for all types of hip fracture surgery. The occurrence of a postoperative complication was significantly higher in patients aged a parts per thousand yen80 years (OR 1.37; p < 0.001) and those with dementia (OR 1.45; p < 0.001), any type of malignancy (OR 1.42; p < 0.001), a history of cardiovascular disease (OR 1.33; p < 0.001), a history of cerebrovascular disease (OR 1.15; p = 0.029), chronic renal failure (OR 1.36; p < 0.001), liver cirrhosis (OR 1.41; p < 0.001) or blood transfusion after surgery (OR 1.49; p < 0.001).Our results highlight the need to pay particular attention to surgical site infection, urinary tract infection and respiratory complications in patients with preoperative dementia after hip fracture surgery. These results provide additional useful evidence to inform the management of these patients.