Surgical timing and clinical factor predicting in-hospital mortality in older adults with hip fractures: a neuronal network analysis.

IF 3 2区 医学 Q1 ORTHOPEDICS
Raffaele Vitiello, Elisa Pesare, Giacomo Capece, Emidio Di Gialleonardo, Andrea De Matthaeis, Francesco Franceschi, Giulio Maccauro, Marcello Covino
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引用次数: 0

Abstract

Introduction: Hip fractures in older adults are associated with a significant mortality rate, which has been reported to be around 35% within a year. Today, the incidence of these fractures is on the rise, and this trend is expected to increase even more owing to the aging of the population. Treatment timing and perioperative management of these patients are typically challenging owing to the presence of multiple comorbidities that are important risk factors for mortality after surgery. This study aims to evaluate the relationship between surgical timing and in-hospital mortality, analyzing the role of both acute events and chronic preexisting comorbidities in patient outcomes.

Materials and methods: This is a single-center, retrospective observational study (from January 2018 until June 2023). All consecutive patients ≥ 65 years with a diagnosis of proximal femur fracture were enrolled. The primary study endpoint was to evaluate risk factors associated with in-hospital mortality. The secondary endpoint was the assessment of the relationship between surgical timing and in-hospital mortality, including factors such as preexisting comorbidities, the Charlson Comorbidity Index, and the Nottingham Hip Fracture Score. The relative weight of each factor for predicting the mortality rate was also evaluated using neural network analysis, comparing patients treated within 24 h to those treated after a longer surgical delay.

Results: Among the 2320 patients enrolled, 1391 (60%) underwent surgery within 24 h, while 929 patients (40%) were treated after 24 h. For patients who underwent surgery within 24 h, the in-hospital mortality was 2.8%, and for those who underwent surgery after 24 h, it was 5.2% (p = 0.046; odds ratio (OR) 1.58). Age (p = 0.001; OR 1.06) and Nottingham score (p = 0.04; OR 1.32) are factors predicting mortality. Acute infections were related to a high risk of mortality (p = 0.001; OR 5.99), both in patients treated within and after 24 h. Acute events, such as atrial fibrillation and electrolyte imbalance, were related to mortality risk only in patients treated within 24 h (p = 0.001 versus p = 0.51). Neural network analysis revealed that atrial fibrillation (AF), flutter, and electrolyte imbalance had the highest relative weight for mortality in patients treated in the first 24 h; by contrast, renal failure and pneumonia were most present in patients who died that were treated after 24 h.

Conclusions: Hip fracture is known to be a significant cause of morbidity and mortality in older adults. The impact of the timing of surgical treatment in those patients is crucial for postoperative outcomes. Early surgery is essential to reduce the risk of mortality. Our study has shown that, while in the case of acute and reversible conditions, waiting about 24 h to stabilize the patient with preoperative stabilization protocols, such as managing anticoagulation, optimizing hemodynamics, or addressing acute medical conditions including infection prevention, guarantees better results, in the case of sepsis or acute infection presence, the prolonged waiting to optimize patients before and after surgery does not help improve outcomes.

预测老年髋部骨折患者住院死亡率的手术时机和临床因素:神经网络分析。
导读:老年人髋部骨折的死亡率很高,据报道,一年内的死亡率约为35%。如今,这些骨折的发生率正在上升,由于人口老龄化,这一趋势预计会进一步增加。由于存在多种合并症,这些患者的治疗时机和围手术期管理通常具有挑战性,这些合并症是术后死亡的重要危险因素。本研究旨在评估手术时机与住院死亡率之间的关系,分析急性事件和慢性既往合并症在患者预后中的作用。材料和方法:这是一项单中心、回顾性观察性研究(2018年1月至2023年6月)。所有连续≥65岁且诊断为股骨近端骨折的患者均被纳入研究。主要研究终点是评估与住院死亡率相关的危险因素。次要终点是评估手术时间和住院死亡率之间的关系,包括先前存在的合并症、Charlson合并症指数和诺丁汉髋部骨折评分等因素。预测死亡率的每个因素的相对权重也使用神经网络分析进行评估,比较24小时内治疗的患者和手术延迟较长时间后治疗的患者。结果:2320例入组患者中,24 h内手术1391例(60%),24 h后治疗929例(40%)。24 h内手术患者住院死亡率为2.8%,24 h后手术患者住院死亡率为5.2% (p = 0.046;优势比(OR) 1.58)。年龄(p = 0.001;OR 1.06)和Nottingham评分(p = 0.04;OR 1.32)是预测死亡率的因素。急性感染与高死亡率相关(p = 0.001;OR 5.99)。急性事件,如心房颤动和电解质失衡,仅在24小时内治疗的患者中与死亡风险相关(p = 0.001对p = 0.51)。神经网络分析显示,房颤(AF)、扑动和电解质失衡在治疗前24小时内对患者死亡率的相对权重最高;相比之下,肾衰竭和肺炎在24小时后死亡的患者中最常见。结论:髋部骨折是老年人发病率和死亡率的重要原因。手术治疗时机的影响对这些患者的术后结果至关重要。早期手术对于降低死亡风险至关重要。我们的研究表明,虽然在急性和可逆性疾病的情况下,等待约24小时来稳定患者的术前稳定方案,如抗凝管理,优化血流动力学,或解决急性医疗条件,包括感染预防,保证更好的结果,在败血症或急性感染存在的情况下,优化患者在手术前和术后的长时间等待无助于改善结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Orthopaedics and Traumatology
Journal of Orthopaedics and Traumatology Medicine-Orthopedics and Sports Medicine
CiteScore
4.30
自引率
0.00%
发文量
56
审稿时长
13 weeks
期刊介绍: The Journal of Orthopaedics and Traumatology, the official open access peer-reviewed journal of the Italian Society of Orthopaedics and Traumatology, publishes original papers reporting basic or clinical research in the field of orthopaedic and traumatologic surgery, as well as systematic reviews, brief communications, case reports and letters to the Editor. Narrative instructional reviews and commentaries to original articles may be commissioned by Editors from eminent colleagues. The Journal of Orthopaedics and Traumatology aims to be an international forum for the communication and exchange of ideas concerning the various aspects of orthopaedics and musculoskeletal trauma.
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