Effect of Chronic Kidney Disease on All-Cause Mortality After Hip Fracture Surgery: A Retrospective Cohort Study.

IF 3.3 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM
Calcified Tissue International Pub Date : 2024-08-01 Epub Date: 2024-06-17 DOI:10.1007/s00223-024-01238-9
Yun Seo Jang, Hyunkyu Kim, Soo Young Kim, Yu Shin Park, Il Yun, Eun-Cheol Park, Suk-Yong Jang
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Abstract

In this retrospective cohort study, we investigated: (1) The impact of comorbid chronic kidney disease (CKD) on postoperative mortality in patients with a hip fracture; (2) mortality variations by dialysis type, potentially indicating CKD stage; (3) the efficacy of different hip fracture surgical methods in reducing mortality for patients with CKD. This study included 25,760 patients from the Korean National Health Insurance Service-Senior cohort (2002-2019) who underwent hip fracture surgery. Participants were categorized as CKD and Non-CKD. Mortality rate was determined using a generalized linear model with a Poisson distribution. The effect size was presented as a hazard ratio (HR) through a Cox proportional-hazard model. During follow-up, we ascertained that 978 patients (3.8%) had CKD preoperatively. Compared to the Non-CKD group, the mortality risk (HR) in the CKD group was 2.17 times higher (95% confidence interval [CI], 1.99-2.37). In sensitivity analysis, the mortality risk of in patients who received peritoneal dialysis and hemodialysis was 6.21 (95% CI, 3.90-9.87) and 3.62 times (95% CI, 3.11-4.20) higher than that of patients who received conservative care. Mortality risk varied by surgical method: hip hemiarthroplasty (HR, 2.11; 95% CI, 1.86-2.40), open reduction and internal fixation (HR, 2.21; 95% CI, 1.94-2.51), total hip replacement (HR, 2.27; 95% CI, 1.60-3.24), and closed reduction and percutaneous fixation (HR, 3.08; 95% CI, 1.88-5.06). Older patients with CKD undergoing hip fracture surgery had elevated mortality risk, necessitating comprehensive pre- and postoperative assessments and management.

Abstract Image

慢性肾病对髋部骨折术后全因死亡率的影响:回顾性队列研究
在这项回顾性队列研究中,我们调查了:(1)合并慢性肾脏疾病(CKD)对髋部骨折患者术后死亡率的影响;(2)透析类型对死亡率的影响,透析类型有可能表明CKD的分期;(3)不同的髋部骨折手术方法对降低CKD患者死亡率的效果。这项研究纳入了韩国国民健康保险服务-老年队列(2002-2019 年)中 25760 名接受髋部骨折手术的患者。参与者被分为 CKD 和非 CKD 两类。死亡率采用泊松分布的广义线性模型确定。效应大小通过考克斯比例危险模型以危险比(HR)表示。在随访期间,我们发现有 978 名患者(3.8%)在术前患有慢性肾功能衰竭。与非 CKD 组相比,CKD 组的死亡风险(HR)高出 2.17 倍(95% 置信区间 [CI],1.99-2.37)。在敏感性分析中,接受腹膜透析和血液透析患者的死亡风险分别是接受保守治疗患者的 6.21 倍(95% CI,3.90-9.87)和 3.62 倍(95% CI,3.11-4.20)。死亡率风险因手术方法而异:髋关节半关节成形术(HR,2.11;95% CI,1.86-2.40)、切开复位内固定术(HR,2.21;95% CI,1.94-2.51)、全髋关节置换术(HR,2.27;95% CI,1.60-3.24)以及闭合复位经皮固定术(HR,3.08;95% CI,1.88-5.06)。患有慢性肾功能衰竭的老年患者接受髋部骨折手术的死亡风险较高,因此有必要进行全面的术前和术后评估与管理。
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来源期刊
Calcified Tissue International
Calcified Tissue International 医学-内分泌学与代谢
CiteScore
8.00
自引率
2.40%
发文量
112
审稿时长
4-8 weeks
期刊介绍: Calcified Tissue International and Musculoskeletal Research publishes original research and reviews concerning the structure and function of bone, and other musculoskeletal tissues in living organisms and clinical studies of musculoskeletal disease. It includes studies of cell biology, molecular biology, intracellular signalling, and physiology, as well as research into the hormones, cytokines and other mediators that influence the musculoskeletal system. The journal also publishes clinical studies of relevance to bone disease, mineral metabolism, muscle function, and musculoskeletal interactions.
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