Pressure ulcers are associated with 6-month mortality in elderly patients with hip fracture managed in orthogeriatric care pathway
Pressure ulcers are associated with 6-month mortality in elderly patients with hip fracture managed in orthogeriatric care pathway
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DOI：
10.1007/s11657-017-0365-9
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发表时间：
2017-08-29
影响因子：
3
通讯作者：
Boddaert, Jacques
中科院分区：
文献类型：
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作者：
Magny, Emmanuelle;Vallet, Helene;Boddaert, Jacques
尽管有骨科治疗，12%的老年人髋部骨折术后出现脓肿。脓毒症与低白蛋白水平、心房颤动、冠状动脉疾病和糖尿病史显著相关。与压疮相关的6个月死亡风险比为2.38 （95% CI 1.31-4.32%, p = 0.044）。压疮在髋部骨折患者中是常见的，并且与不良预后相关。国际髋部骨折患者指南推荐的包括压疮预防和治疗在内的正老年病管理可能影响压疮的起因和后果。然而，与压疮发生相关的其他因素以及在骨科护理途径中管理的髋部骨折患者压疮的预后价值仍然未知。方法2009年6月至2015年4月，对所有髋部骨折患者进行术后老年护理评估。如果患者的主要表现是髋部骨折，如果他们的年龄在bb0 = 70岁，则纳入研究。患者被排除在病理性骨折或如果他们已经住院在骨折的时间。在我们的单位，正老年病的原则实施，包括多成分干预，以改善压疮的预防和管理。随访至出院后6个月。结果纳入567例患者，6个月总死亡率为14.4% （95% CI 11.6-17.8%）。其中，67名患者（12%）经历了至少一次压疮。尽管进行了正老性治疗，压疮仍与低白蛋白水平（RR 0.90, 95% CI 0.84-0.96; p = 0.003）、房颤史（RR 1.91, 95% CI 1.05-3.46; p = 0.033）、冠状动脉疾病（RR 2.16, 95% CI 1.17-3.99; p = 0.014）和糖尿病（RR 2.33, 95% CI 1.14-4.75; p = 0.02）显著相关。压疮与6个月死亡率相关（RR 2.38, 95% CI 1.31-4.32, p = 0.044）。结论：在老年髋部骨折患者的骨科护理路径中，压疮仍与难以改变的危险因素和长期死亡率相关。
Despite orthogeriatric management, 12% of the elderly experienced PUs after hip fracture surgery. PUs were significantly associated with a low albumin level, history of atrial fibrillation coronary artery disease, and diabetes. The risk ratio of death at 6 months associated with pressure ulcer was 2.38 (95% CI 1.31-4.32%, p = 0.044).Introduction Pressure ulcers in hip fracture patients are frequent and associated with a poor outcome. An orthogeriatric management, recommended by international guidelines in hip fracture patients and including pressure ulcer prevention and treatment, could influence causes and consequences of pressure ulcer. However, remaining factors associated with pressure ulcer occurrence and prognostic value of pressure ulcer in hip fracture patients managed in an orthogeriatric care pathway remain unknown.Methods From June 2009 to April 2015, all consecutive patients with hip fracture admitted to a unit for Post-operative geriatric care were evaluated for eligibility. Patients were included if their primary presentation was due to hip fracture and if they were >= 70 years of age. Patients were excluded in the presence of pathological fracture or if they were already hospitalized at the time of the fracture. In our unit, orthogeriatric principles are implemented, including a multicomponent intervention to improve pressure ulcer prevention and management. Patients were followed-up until 6 months after discharge.Results Five hundred sixty-seven patients were included, with an overall 14.4% 6-month mortality (95% CI 11.6-17.8%). Of these, 67 patients (12%) experienced at least one pressure ulcer. Despite orthogeriatric management, pressure ulcers were significantly associated with a low albumin level (RR 0.90, 95% CI 0.84-0.96; p = 0.003) and history of atrial fibrillation (RR 1.91, 95% CI 1.05-3.46; p = 0.033), coronary artery disease (RR 2.16, 95% CI 1.17-3.99; p = 0.014), and diabetes (RR 2.33, 95% CI 1.14-4.75; p = 0.02). A pressure ulcer was associated with 6-month mortality (RR 2.38, 95% CI 1.31-4.32, p = 0.044).Conclusion In elderly patients with hip fracture managed in an orthogeriatric care pathway, pressure ulcer remained associated with poorly modifiable risk factors and long-term mortality.