在共同管理的骨科病房中,髋部骨折术后不坚持早期院内康复计划的预测因素

IF 3.4 3区 医学 Q2 GERIATRICS & GERONTOLOGY
Roberto Presta, Enrico Brunetti, Valeria Quaranta, Silvio Raspo, Paola Cena, Giulia Carignano, Martina Bonetto, Chiara Busso, Gianluca Isaia, Marco Marabotto, Giuseppe Massazza, Mario Bo
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引用次数: 0

摘要

背景髋部骨折是老年人的常见病,会增加死亡、残疾和医疗费用的风险。在老年骨科病房进行术后早期院内康复治疗可改善预后,即使是高龄老人也能减少并发症的发生。我们的目的是确定一家意大利三级医院的老年矫形科未坚持早期康复治疗的发生率和预测因素,及其对出院时的治疗效果和环境的影响。在2019年4月至2020年10月期间,因髋部骨折入住老年骨科病房并接受手术治疗的患者年龄≥65岁,如果能够自主行走或在他人协助下行走,并能独立完成至少2项基本日常生活活动,则被视为符合条件。除社会人口学和老年学变量外,还收集了手术和康复的特点、院内并发症和出院时的功能结果。结果 在283名老年患者(平均年龄82.7岁,28.6%为男性)中,有49人(17.3%)未遵守物理治疗,其特点是骨折前的临床、认知和功能状态较差,出院时的活动能力也较差。经过多变量分析,不坚持理疗与谵妄(OR 5.26,95%CI 2.46-11.26;P <;0.001)或术后感染(OR 3.26,95%CI 1.54-6.89;P <;0.001)以及入院时收缩压 <;120 mmHg(OR 4.52,95%CI 1.96-10.43,P <;0.结论 骨折前认知和功能状态不佳以及收缩压较低似乎使一些患者更容易出现院内并发症(主要是谵妄和感染),并对坚持物理治疗产生负面影响,进而影响康复的临床效果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Predictors of non-adherence to an early in-hospital rehabilitation program after surgery for hip fracture in a co-managed orthogeriatric unit

Background

Hip fracture is a common event in older adults, leading to an increased risk of mortality, disability, and higher healthcare costs. Early in-hospital rehabilitation after surgery within orthogeriatric units may improve outcomes with limited incident complications even in the oldest old. We aimed to determine the prevalence and predictors of non-adherence to early rehabilitation in the orthogeriatric unit of an Italian tertiary hospital and its impact on outcomes and setting at discharge.

Methods

Retrospective observational single-centered cohort study. Patients aged ≥ 65 years admitted to the orthogeriatric unit for hip fracture who underwent surgery between April 2019 and October 2020 were considered eligible if able to walk autonomously or with assistance and independent in at least 2 Basic Activities of Daily Living. Along with sociodemographic and geriatric variables, characteristics of surgery and rehabilitation, in-hospital complications and functional outcomes at discharge were collected. The primary outcome was non-adherence to the early in-hospital rehabilitation program.

Results

Among 283 older patients (mean age 82.7 years, 28.6% male), non-compliance with physical therapy was assessed in 49 cases (17.3%), characterized by worse pre-fracture clinical, cognitive, and functional status and showing worse outcomes in terms of mobilization at discharge. After multivariable analysis, non-adherence was independently associated with the onset of delirium (OR 5.26, 95%CI 2.46–11.26; p < 0.001) or infections after surgery (OR 3.26, 95%CI 1.54–6.89; p < 0.001) and a systolic blood pressure at admission < 120 mmHg (OR 4.52, 95%CI 1.96–10.43, p < 0.001).

Conclusions

Pre-fracture poor cognitive and functional status, along with lower systolic blood pressure, seem to make some patients more vulnerable to in-hospital complications (mainly delirium and infections) and negatively affect the adherence to physical therapy and, by consequence, clinical outcomes of rehabilitation.

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来源期刊
CiteScore
7.90
自引率
5.00%
发文量
283
审稿时长
1 months
期刊介绍: Aging clinical and experimental research offers a multidisciplinary forum on the progressing field of gerontology and geriatrics. The areas covered by the journal include: biogerontology, neurosciences, epidemiology, clinical gerontology and geriatric assessment, social, economical and behavioral gerontology. “Aging clinical and experimental research” appears bimonthly and publishes review articles, original papers and case reports.
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