80岁及以上髋部骨折患者术后院内死亡因素分析△（开放获取）

Factors related to in-hospital death in patients aged 80 years and above after surgery for hip fractures

摘要:

[目的] 探讨 80 岁及以上老年髋部骨折患者术后院内死亡的病例特征及危险因素。[方法] 回顾性分析 2019 年 10 月-2024 年 3 月聊城市人民医院 80 岁及以上的髋部骨折手术 725 例患者的临床资料。根据住院期间是否发生院内死亡分为死亡组和生存组。采用单因素比较和多因素逻辑回归分析术后院内死亡的危险因素。[结果]725 例患者中，24 例患者发生术后院内死亡，占 3.3%；主要直接死亡原因为肺部感染 [14 (58.3%)] 和急性心梗 [4 (16.7%)]。单因素比较表明，死亡组与生存组在男性比例 [例, 男/女, (15/9) vs (196/505), P＜0.001]、伤前 ADL 评分 [(4.7±0.9) vs (5.4±1.1), P=0.001]、损伤能量 [例, 低/中/高, (0/21/ 3) vs (6/679/16), P=0.036]、并存慢性肺疾病 [例 (%), 8 (33.3) vs 115 (16.4), P=0.047]、白细胞水平 [(9.6±2.4)×109 /L vs (8.4±2.8)×109 /L, P=0.042]、白蛋白水平 [(32.8±4.1) g/L vs (34.5±4.2) g/L, P=0.047]、尿素水平 [(10.3±7.6) mmol/L vs (6.8±3.2) mmol/L, P=0.035]、入室血氧饱和度 [(92.4±6.5)% vs (95.2±4.3)%, P=0.047]、术中输血 [例 (%), 6 (25) vs 71(10.1), P=0.033]、术后转入 ICU [例 (%), 16 (66.7) vs 32 (4.6), P＜0.001] 的差异有统计学意义。多因素逻辑回归分析显示，男性 （OR=3.202, P=0.023）、术前肌酐水平高 （OR= 1.013, P=0.002） 及术后转入 ICU （OR=51.892, P＜0.001） 是 80 岁及以上老年髋部骨折患者术后院内死亡的独立危险因素。[结论]肺部感染是高龄髋部骨折患者术后院内死亡的主要直接原因。男性、术前肌酐水平高及术后转入 ICU，是术后院内死亡的独立危险因素。

Abstract:

[Objective] To investigate the clinical characteristics and risk factors of in-hospital death in patients ≥80 years after surgery for hip fractures. [Methods] A retrospective study was conducted on 725 patients aged ≥80 years who underwent surgical treatment for hip fractures in People's Hospital of Liaocheng City from October 2019 to March 2024. They were divided into the death group and the survival group according to whether death occurred during hospitalization. Univariate comparison and multiple logistic regression were used to analyze the risk factors for the in-hospital death. [Results] Of the 725 patients, 24 died in hospital, accounting for 3.3% with immediate death causes of pulmonary infection [14 (58.3%)] and acute myocardial infarction [4 (16.7%)]. As results of univariate comparison, there were statistically significant differences between the death group and the survival group in the following items: gender [n, male/female, (15/ 9) vs (196/505), P 0.001], ADL scores before injury [(4.7±0.9) vs (5.4±1.1), P 0.001], damage energy [low/medium/high, (0/21/3) vs (6/679/ 16), P 0.036], coexisting chronic pulmonary disease [n (%) 8 (33.3)vs 115 (16.4), P 0.047], leukocyte level [(9.6±2.4) 109 /L vs (8.4±2.8) 109 / L, P 0.042], albumin [(32.8±4.1) g/L vs (34.5±4.2) g/L, P 0.047], urea [(10.3±7.6) mmol/L vs (6.8±3.2) mmol/L, P 0.035], oxygen saturation before operation [(92.4±6.5)% vs (95.2±4.3)%, P 0.047], intraoperative blood transfusion [n (%) 6 (25) vs 71 (10.1), P 0.033], and postoperative ICU stay [n (%) 16 (66.7) vs 32 (4.6), P 0.001]. Regarding multivariate logistic regression analysis, the male (OR=3.202,P= 0.023), high preoperative creatinine (OR=1.013,P=0.002) and postoperative ICU stay (OR=51.892, P＜0.001) were the independent risk factors for in-hospital death in elderly patients ≥80 years old after operation for hip fractures. [Conclusion] Pulmonary infection is the main direct cause of in-hospital death in elderly patients after surgery for hip fractures. In addition, male gender, high preoperative creatinine and postoperative ICU stay are independent risk factors for the in-hospital death.