Prediction of Mortality in Nonagenarians Following the Surgical Repair of Hip Fractures
Prediction of Mortality in Nonagenarians Following the Surgical Repair of Hip Fractures
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DOI：
10.4055/cios.2016.8.2.140
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发表时间：
2016-01-01
影响因子：
2.5
通讯作者：
Ebraheim, Nabil
中科院分区：
文献类型：
--
作者：
Fansa, Ashraf;Huff, Scott;Ebraheim, Nabil
背景资料：本研究的目的是报告因髋部骨折接受手术治疗的90岁老人的死亡率，特别是关于先前存在的合并症。此外，我们评估了有效性的Deyo评分在预测这种mortality.Methods：39例年龄超过90岁的髋关节骨折手术修复进行了回顾性分析。股骨颈骨折26例（66.7%），转子型骨折13例（33.3%）。患者的图表进行了检查，以确定以前诊断的患者合并症，以及生活安排和流动性术前和术后surgical.Results：Deyo指数评分没有表现出统计学显着相关性与术后死亡率或功能的结果。在无充血性心力衰竭（CHF）和慢性肺病（CPD）病史的患者中，住院死亡率的风险分别降低了91%（p = 0.036）和86%（p = 0.05）。此外，在无痴呆和CPD病史的患者中，90天死亡率的风险分别降低了88%（p = 0.01）和81%（p = 0.024）。在无痴呆和CPD病史的患者中，1年死亡率的风险分别降低了75%（p = 0.01）和80%（p = 0.01）。此外，痴呆症患者术后平均住院5.3天（p = 0.013）比非痴呆症患者，只有38.5%的患者恢复到术前的生活条件（p = 0.036）。结论：90岁以上的CHF和CPD的历史有较高的风险，在髋关节骨折手术修复后的住院死亡率。90岁以上的CPD和痴呆患者术后90天和1年的死亡风险较高。痴呆症患者也比非痴呆症患者出院更快。
Background: The purpose of this study is to report on the mortality of nonagenarians who underwent surgical treatment for a hip fracture, specifically in regards to preexisting comorbidities. Furthermore, we assessed the effectiveness of the Deyo score in predicting such mortality.Methods: Thirty-nine patients over the age of 90 who underwent surgical repair of a hip fracture were retrospectively analyzed. Twenty-six patients (66.7%) suffered femoral neck fractures, while the remaining 13 (33.3%) presented with trochanteric type fractures. Patient charts were examined to determine previously diagnosed patient comorbidities as well as living arrangements and mobility before and after surgery.Results: Deyo index scores did not demonstrate statistically significant correlations with postoperative mortality or functional outcomes. The hazard of in-hospital mortality was found to be 91% (p = 0.036) and 86% (p = 0.05) less in patients without a history of congestive heart failure (CHF) and chronic pulmonary disease (CPD), respectively. Additionally, the hazard of 90-day mortality was 88% (p = 0.01) and 81% (p = 0.024) less in patients without a history of dementia and CPD, respectively. The hazard of 1-year mortality was also found to be 75% (p = 0.01) and 80% (p = 0.01) less in patients without a history of dementia and CPD, respectively. Furthermore, dementia patients stayed in-hospital postoperatively an average of 5.3 days (p = 0.013) less than nondementia patients and only 38.5% returned to preoperative living conditions (p = 0.036).Conclusions: Nonagenarians with a history of CHF and CPD have a higher risk of in-hospital mortality following the operative repair of hip fractures. CPD and dementia patients over 90 years old have higher 90-day and 1-year mortality hazards postoperatively. Dementia patients are also discharged more quickly than nondementia patients.