Evaluating the Severity Spectrum: A Hierarchical Analysis of Complications during Hip Fracture Admission Associated with Mortality.

IF 1.6 3区 医学 Q3 ORTHOPEDICS
Christopher J Pettit, Carolyn F Herbosa, Abhishek Ganta, Steven Rivero, Nirmal Tejwani, Philipp Leucht, Sanjit R Konda, Kenneth A Egol
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Abstract

Objectives: To determine which in-hospital complications following the operative treatment of hip fractures are associated with increased inpatient, 30-day and 1 year mortality.

Methods: Design: Retrospective study.

Setting: A single academic medical center and a Level 1 Trauma Center.

Patient selection criteria: All patients who were operatively treated for hip fractures (OTA/AO 31A, 31B and Vancouver A,B, and C periprosthetic fractures) at a single center between October, 2014 and June, 2023.

Outcome measures and comparisons: Occurrence of an in-hospital complication was recorded. Cohorts were based upon mortality time points (during admission, 30-days and 1-year) and compared to patients who were alive at those time points to determine which in- hospital complications were most associated with mortality. Correlation analysis was performed between patients who died and those who were alive at each time point.

Results: A total of 3,134 patients (average age of 79.6 years, range 18-104 years and 66.6% female) met inclusion for this study. The overall mortality rate during admission, 30 days and 1 year were found to be 1.6%, 3.9% and 11.1%, respectively. Sepsis was the complication most associated with increased in-hospital mortality (OR: 7.79, 95% CI 3.22 - 18.82, p<0.001) compared to other in-hospital complications. Compared to other in-hospital complications, stroke was the complication most associated with 30-day mortality (OR: 7.95, 95% CI 1.82 - 34.68, p<0.001). Myocardial infarction was the complication most associated with 1-year mortality (OR: 2.86, 95% CI 1.21 - 6.77, p=0.017) compared to other in-hospital complications.

Conclusions: Post-operative sepsis, stroke and myocardial infraction were the three complications most associated with mortality during admission, 30-day mortality and 1-year mortality, respectively, during the operative treatment of hip fractures.

Level of evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

评估严重程度:髋部骨折入院期间与死亡率相关并发症的层次分析。
目的确定髋部骨折手术治疗后哪些院内并发症与住院、30 天和 1 年死亡率的增加有关:设计:回顾性研究:设计:回顾性研究:患者选择标准:2014年10月至2023年6月期间在单一中心接受手术治疗的所有髋部骨折(OTA/AO 31A、31B和温哥华A、B和C型假体周围骨折)患者:记录院内并发症的发生情况。根据死亡率时间点(入院期间、30 天和 1 年)进行分组,并与在这些时间点存活的患者进行比较,以确定哪些院内并发症与死亡率关系最大。对每个时间点的死亡患者和存活患者进行了相关性分析:共有 3,134 名患者(平均年龄 79.6 岁,18-104 岁不等,66.6% 为女性)符合研究要求。入院、30 天和 1 年的总死亡率分别为 1.6%、3.9% 和 11.1%。脓毒症是与院内死亡率增加最相关的并发症(OR:7.79,95% CI 3.22 - 18.82,p结论:在髋部骨折的手术治疗中,术后败血症、中风和心肌梗死分别是与入院时死亡率、30天死亡率和1年死亡率最相关的三种并发症:预后III级。有关证据等级的完整描述,请参见 "作者须知"。
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来源期刊
Journal of Orthopaedic Trauma
Journal of Orthopaedic Trauma 医学-运动科学
CiteScore
3.90
自引率
8.70%
发文量
396
审稿时长
3-8 weeks
期刊介绍: Journal of Orthopaedic Trauma is devoted exclusively to the diagnosis and management of hard and soft tissue trauma, including injuries to bone, muscle, ligament, and tendons, as well as spinal cord injuries. Under the guidance of a distinguished international board of editors, the journal provides the most current information on diagnostic techniques, new and improved surgical instruments and procedures, surgical implants and prosthetic devices, bioplastics and biometals; and physical therapy and rehabilitation.
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