老年髋部骨折患者术后2型糖尿病的风险:一项倾向评分匹配研究

IF 2.2 3区 医学 Q3 ENDOCRINOLOGY & METABOLISM
Yu Mori, Kunio Tarasawa, Hidetatsu Tanaka, Naoko Mori, Kiyohide Fushimi, Toshimi Aizawa, Kenji Fujimori
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引用次数: 0

摘要

2型糖尿病与脆性骨折的风险增加有关,即使在骨密度正常或高的个体中也是如此。然而,2型糖尿病对日本老年患者髋部骨折术后预后的影响尚不清楚。本研究利用日本全国数据库评估了2型糖尿病与术后并发症(包括住院死亡率)之间的关系。材料和方法:2016年4月至2022年3月,使用诊断程序组合(DPC)数据库进行回顾性队列研究。年龄≥65岁并接受髋部骨折手术的患者纳入研究。进行倾向评分匹配(1:1)以调整混杂因素。Logistic回归分析用于评估2型糖尿病与预后之间的关系。结果:纳入本研究的474,293例符合条件的患者中,18.5%被确定患有合并症2型糖尿病。按照1:1的倾向评分匹配,最终的分析队列包括83,283名患者。虽然具有统计学意义,但2型糖尿病的存在仅与术后心肌梗死(风险差[RD]: 0.0007)、认知功能障碍(RD: 0.0029)和住院死亡率(RD: 0.0045)的风险适度增加相关,所有比较的p值均小于0.0001。此外,2型糖尿病患者的住院时间更长。结论:尽管绝对风险差异很小,但2型糖尿病仍然是日本老年患者髋部骨折术后不良预后的独立危险因素。量身定制的围手术期策略可能有助于优化这一弱势群体的预后。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Postoperative risks of type 2 diabetes in elderly hip fracture patients: a propensity score-matched study.

Introduction: Type 2 diabetes is associated with an increased risk of fragility fractures, even in individuals with normal or high bone mineral density. However, the impact of type 2 diabetes on postoperative outcomes after hip fracture surgery in elderly Japanese patients remains unclear. This study evaluated the association between type 2 diabetes and postoperative complications, including in-hospital mortality, using a nationwide database in Japan.

Materials and methods: A retrospective cohort study was conducted using the Diagnosis Procedure Combination (DPC) database from April 2016 to March 2022. Patients aged ≥ 65 years who underwent hip fracture surgery were included. Propensity score matching (1:1) was performed to adjust for confounders. Logistic regression analyses were used to assess associations between type 2 diabetes and outcomes.

Results: Of the 474,293 eligible patients included in this study, 18.5% were identified as having comorbid type 2 diabetes. Following 1:1 propensity score matching, the final analytic cohorts each comprised 83,283 patients. Although statistically significant, the presence of type 2 diabetes was associated with only modest increases in the risks of postoperative myocardial infarction (risk difference [RD]: 0.0007), cognitive dysfunction (RD: 0.0029), and in-hospital mortality (RD: 0.0045), with all comparisons yielding p-values of less than 0.0001. Additionally, the length of hospital stay was longer among patients with type 2 diabetes.

Conclusions: Although the absolute risk differences were small, type 2 diabetes remains an independent risk factor for adverse postoperative outcomes following hip fracture surgery in elderly Japanese patients. Tailored perioperative strategies may help optimize outcomes in this vulnerable population.

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来源期刊
Journal of Bone and Mineral Metabolism
Journal of Bone and Mineral Metabolism 医学-内分泌学与代谢
CiteScore
6.30
自引率
3.00%
发文量
89
审稿时长
6-12 weeks
期刊介绍: The Journal of Bone and Mineral Metabolism (JBMM) provides an international forum for researchers and clinicians to present and discuss topics relevant to bone, teeth, and mineral metabolism, as well as joint and musculoskeletal disorders. The journal welcomes the submission of manuscripts from any country. Membership in the society is not a prerequisite for submission. Acceptance is based on the originality, significance, and validity of the material presented. The journal is aimed at researchers and clinicians dedicated to improvements in research, development, and patient-care in the fields of bone and mineral metabolism.
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