Does weightbearing status impact mortality and other complications in hip fracture patients when accounting for frailty?

IF 2.8 Q1 ORTHOPEDICS
Makoa Mau, Tyler Thorne, Kai Rossbach, Eleanor H Sato, Chong Zhang, Angela P Presson, Justin M Haller
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引用次数: 0

Abstract

Aims: The aim of this study was to analyze the risk of mortality and other postoperative complications following restricted weightbearing in geriatric patients who undergo fixation of a hip fracture, while accurately controlling for patient frailty.

Methods: The National Surgical Quality Improvement Program (NSQIP) database January 2016 to December 2020 was queried for operatively treated hip fractures in patients aged ≥ 60 years using Current Procedural Terminology (CPT) codes (n = 53,959). Logistic regressions and receiver operating characteristic (ROC) curve analysis were conducted to determine the frailty measure which best predicts 30-day mortality among American Society of Anesthesiologists grade (ASA), five-factor modified Fraility Index (mFI-5), and Risk Analysis Index Recalibrated Version (RAI-Rev). The effect of weightbearing on 30-day mortality, and severe (SAE) and minor (MAE) adverse events, was assessed using logistic regressions while controlling for the selected frailty measure and other relevant patient characteristics.

Results: A total of 53,959 patients met the inclusion criteria, and 36,177 patients (67%) were weightbearing as tolerated postoperatively. Under ROC curve, the only discriminatory performance was by RAI-Rev in 30-day mortality. Controlling for RAI-Rev, age, sex, BMI, functional status, and CPT, weightbearing patients had a 42% lower odds of 30-day mortality (p < 0.001), a 31% lower odds of a SAE (p < 0.001), and a 24% lower odds of a MAE (p < 0.001) in comparison to non-weightbearing patients.

Conclusion: Geriatric hip fractures are prevalent in patients with varying degrees of health. RAI-Rev is a better predictor of postoperative mortality than ASA grade and mFI-5, and should be used in evaluating the risk of geriatric hip fractures. Postoperative weightbearing is associated with significant reductions in complications for geriatric hip fracture patients, even while controlling for frailty. Our findings suggest that postoperative weightbearing after surgical fixation of geriatric hip fractures should be encouraged for able patients.

当考虑到虚弱时,负重状态是否会影响髋部骨折患者的死亡率和其他并发症?
目的:本研究的目的是分析接受髋部骨折固定的老年患者限制负重后的死亡率和其他术后并发症的风险,同时准确控制患者的虚弱。方法:使用现行程序术语(CPT)代码(n = 53,959)查询2016年1月至2020年12月国家外科质量改进计划(NSQIP)数据库中年龄≥60岁的手术治疗的髋部骨折患者。通过Logistic回归和受试者工作特征(ROC)曲线分析,确定美国麻醉医师学会分级(ASA)、五因素修正的衰弱指数(mFI-5)和风险分析指数再校准版(RAI-Rev)中最能预测30天死亡率的衰弱指标。体重对30天死亡率、严重(SAE)和轻微(MAE)不良事件的影响,在控制选定的虚弱指标和其他相关患者特征的情况下,使用logistic回归进行评估。结果:53959例患者符合纳入标准,36177例(67%)患者术后耐受负重。ROC曲线下,只有RAI-Rev在30天死亡率上具有歧视性。在控制RAI-Rev、年龄、性别、BMI、功能状态和CPT等因素后,与非负重患者相比,负重患者30天死亡率降低42% (p < 0.001), SAE发生率降低31% (p < 0.001), MAE发生率降低24% (p < 0.001)。结论:老年髋部骨折在不同健康程度的患者中普遍存在。与ASA分级和mFI-5相比,RAI-Rev是更好的术后死亡率预测指标,应用于评估老年髋部骨折的风险。术后负重与老年髋部骨折患者并发症的显著减少相关,即使在控制虚弱的情况下也是如此。我们的研究结果表明,老年髋部骨折手术固定后,应鼓励有能力的患者术后负重。
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
Bone & Joint Open
Bone & Joint Open ORTHOPEDICS-
CiteScore
5.10
自引率
0.00%
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审稿时长
8 weeks
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