Risk factors analysis for postoperative mortality of elder patients with intertrochanteric fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 RUI Yunfeng ^1,2,3,4,5 , LU Panpan ^1,2,3,4,5 , LI Yingjuan ^2,5,6 , DAI Guangchun ^1,2,3,4,5 , MA Binbin ^1,2,3,4 , ZOU Jihong ^2,5,6 , CHEN Hui ^1,2,3,4,5 , WANG Chen ^1,2,3,4,5

1. Department of Orthopedic Trauma, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China;
2. Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China;
3. Trauma Center, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China;
4. Orthopaedic Trauma Institute of Southeast University, Nanjing Jiangsu, 210009, P.R.China;
5. School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P.R.China;
6. Department of Geriatrics, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China;

Corresponding author：

RUI Yunfeng, Email: ruiyunfeng@126.com

Keywords：

Intertrochanteric fracture; internal fixation; the elderly; mortality; risk factor

DOI：

10.7507/1002-1892.201906079

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Objective To analyze the risk factors for postoperative mortality of elder patients with intertrochanteric fractures.Methods Patients with intertrochanteric fractures who underwent proximal femoral interlocking intramedullary nail fixation between January 2014 and December 2015 were enrolled in the study. Among them, 135 patients who met the selection criteria were included in the study, and the clinical data were collected, including gender, age, time from admission to surgery, comorbidities, and preoperative hemoglobin, albumin, and total lymphocyte count (TLC), and nutritional status. Univariate analysis and Cox proportional hazards regression model were used to screen the risk factors for postoperative mortality.Results Twenty-seven patients (20.0%) died within 2 years after surgery, and 16 (11.9%) died within 1 year after surgery. Univariate analysis showed that age, coronary atherosclerotic heart disease, number of comorbidities, preoperative hemoglobin and albumin levels were the influencing factors of postoperative mortality in elder patients with intertrochanteric fractures treated with proximal femoral interlocking intramedullary nail fixation (P<0.05). Multivariate analysis showed that age (≥80 years), combined more than 2 medical diseases, and preoperative albumin (<35 g/L) were the independent risk factors for postoperative mortality (P<0.05).Conclusion To improve the clinical outcomes, perioperative risk should be comprehensively evaluated and perioperative management strengthened in the elder patients with intertrochanteric fractures, especially those with advanced age, more combined diseases, and low albumin, for the high postoperative mortality.

Citation： RUI Yunfeng, LU Panpan, LI Yingjuan, DAI Guangchun, MA Binbin, ZOU Jihong, CHEN Hui, WANG Chen. Risk factors analysis for postoperative mortality of elder patients with intertrochanteric fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(12): 1538-1542. doi: 10.7507/1002-1892.201906079 Copy

1.	李明东, 胡稷杰, 黎早敏, 等. 不同手术方式治疗老年股骨粗隆间骨折的疗效比较. 中国修复重建外科杂志, 2017, 31(6): 653-658.
2.	鲁攀攀, 马彬彬, 李荥娟, 等. 老年髋部骨折患者术前营养不良的危险因素分析. 中华老年骨科与康复电子杂志, 2018, 4(3): 145-150.
3.	Kesmezacar H, Ayhan E, Unlu MC, et al. Predictors of mortality in elderly patients with an intertrochanteric or a femoral neck fracture. J Trauma, 2010, 68(1): 153-158.
4.	Fox KM, Magaziner J, Hebel JR, et al. Intertrochanteric versus femoral neck hip fractures: differential characteristics, treatment, and sequelae. J Gerontol A Biol Sci Med Sci, 1999, 54(12): M635-M640.
5.	孙奇, 童培建, 徐斌斌, 等. 老年股骨转子间骨折术后一年死亡率及其危险因素分析. 中华创伤骨科杂志, 2013, 15(5): 371-376.
6.	张世民, 张英琪, 李清, 等. 内侧皮质正性支撑复位对老年股骨粗隆间骨折内固定效果的影响. 中国矫形外科杂志, 2014, 22(14): 1256-1261.
7.	O’Daly BJ, Walsh JC, Quinlan JF, et al. Serum albumin and total lymphocyte count as predictors of outcome in hip fractures. Clin Nutr, 2010, 29(1): 89-93.
8.	中华医学会骨科学分会骨质疏松学组. 骨质疏松性骨折诊疗指南. 中华骨科杂志, 2017, 37(1): 1-10.
9.	张宇, 秦晓东, 许艺荠, 等. 老年股骨转子间骨折术后 1 年死亡率及危险因素分析. 中华老年骨科与康复电子杂志, 2018, 4(5): 277-281.
10.	Kilci O, Un C, Sacan O, et al. Postoperative mortality after hip fracture surgery: A 3 years follow up. PLoS One, 2016, 11(10): e0162097.
11.	Roche JJ, Wenn RT, Sahota O, et al. Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: prospective observational cohort study. BMJ, 2005, 331(7529): 1374.
12.	Mnif H, Koubaa M, Zrig M, et al. Elderly patient’s mortality and morbidity following trochanteric fracture. A prospective study of 100 cases. Orthop Traumatol Surg Res, 2009, 95(7): 505-510.
13.	Kovar FM, Endler G, Wagner OF, et al. Basal haemoglobin levels as prognostic factor for early death in elderly patients with a hip fracture—A twenty year observation study. Injury, 2015, 46(6): 1018-1022.
14.	Fowler AJ, Ahmad T, Phull MK, et al. Meta-analysis of the association between preoperative anaemia and mortality after surgery. Br J Surg, 2015, 102(11): 1314-1324.
15.	Gupta BP, Huddleston JM, Kirkland LL, et al. Clinical presentation and outcome of perioperative myocardial infarction in the very elderly following hip fracture surgery. J Hosp Med, 2012, 7(9): 713-716.
16.	王振恒, 方永超, 阚翔翔, 等. 影响老年髋部骨折患者术后 1 年死亡率的因素分析. 中国矫形外科杂志, 2014, 22(2): 110-114.
17.	Lu J, Chen YY, Zhang L, et al. Laboratory nutritional parameters predict one-year mortality in elderly patients with intertrochanteric fracture. Asia Pac J Clin Nutr, 2016, 25(3): 457-463.
18.	Bhaskar D, Parker MJ. Haematological indices as surrogate markers of factors affecting mortality after hip fracture. Injury, 2011, 42(2): 178-182.
19.	Khan SK, Kalra S, Khanna A, et al. Timing of surgery for hip fractures: a systematic review of 52 published studies involving 291, 413 patients. Injury, 2009, 40(7): 692-697.
20.	Moja L, Piatti A, Pecoraro V, et al. Timing matters in hip fracture surgery: patients operated within 48 hours have better outcomes. A meta-analysis and meta-regression of over 190, 000 patients. PLoS One, 2012, 7(10): e46175.
21.	Novack V, Jotkowitz A, Etzion O, et al. Does delay in surgery after hip fracture lead to worse outcomes? A multicenter survey. Int J Qual Health Care, 2007, 19(3): 170-176.
22.	Shiga T, Wajima Z, Ohe Y. Is operative delay associated with increased mortality of hip fracture patients? Systematic review, meta-analysis, and meta-regression. Can J Anaesth, 2008, 55(3): 146-154.
23.	Tulic G, Dubljanin-Raspopovic E, Tomanovic-Vujadinovic S, et al. Prolonged pre-operative hospital stay as a predictive factor for early outcomes and mortality after geriatric hip fracture surgery: a single institution open prospective cohort study. Int Orthop, 2018, 42(1): 25-31.
24.	王晓伟, 何红英, 张建政, 等. 老年髋部骨折术后长期病死率及相关危险因素分析. 中华创伤骨科杂志, 2018, 20(9): 763-767.
25.	Cornwall R, Gilbert MS, Koval KJ, et al. Functional outcomes and mortality vary among different types of hip fractures: a function of patient characteristics. Clin Orthop Relat Res, 2004, (425): 64-71.
26.	戴兵, 骆洪涛, 孟祥德, 等. 骨折类型与老年髋部骨折术后疗效分析. 中华临床医师杂志(电子版), 2010, 4(5): 630-634.

1. 李明东, 胡稷杰, 黎早敏, 等. 不同手术方式治疗老年股骨粗隆间骨折的疗效比较. 中国修复重建外科杂志, 2017, 31(6): 653-658.
2. 鲁攀攀, 马彬彬, 李荥娟, 等. 老年髋部骨折患者术前营养不良的危险因素分析. 中华老年骨科与康复电子杂志, 2018, 4(3): 145-150.
3. Kesmezacar H, Ayhan E, Unlu MC, et al. Predictors of mortality in elderly patients with an intertrochanteric or a femoral neck fracture. J Trauma, 2010, 68(1): 153-158.
4. Fox KM, Magaziner J, Hebel JR, et al. Intertrochanteric versus femoral neck hip fractures: differential characteristics, treatment, and sequelae. J Gerontol A Biol Sci Med Sci, 1999, 54(12): M635-M640.
5. 孙奇, 童培建, 徐斌斌, 等. 老年股骨转子间骨折术后一年死亡率及其危险因素分析. 中华创伤骨科杂志, 2013, 15(5): 371-376.
6. 张世民, 张英琪, 李清, 等. 内侧皮质正性支撑复位对老年股骨粗隆间骨折内固定效果的影响. 中国矫形外科杂志, 2014, 22(14): 1256-1261.
7. O’Daly BJ, Walsh JC, Quinlan JF, et al. Serum albumin and total lymphocyte count as predictors of outcome in hip fractures. Clin Nutr, 2010, 29(1): 89-93.
8. 中华医学会骨科学分会骨质疏松学组. 骨质疏松性骨折诊疗指南. 中华骨科杂志, 2017, 37(1): 1-10.
9. 张宇, 秦晓东, 许艺荠, 等. 老年股骨转子间骨折术后 1 年死亡率及危险因素分析. 中华老年骨科与康复电子杂志, 2018, 4(5): 277-281.
10. Kilci O, Un C, Sacan O, et al. Postoperative mortality after hip fracture surgery: A 3 years follow up. PLoS One, 2016, 11(10): e0162097.
11. Roche JJ, Wenn RT, Sahota O, et al. Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: prospective observational cohort study. BMJ, 2005, 331(7529): 1374.
12. Mnif H, Koubaa M, Zrig M, et al. Elderly patient’s mortality and morbidity following trochanteric fracture. A prospective study of 100 cases. Orthop Traumatol Surg Res, 2009, 95(7): 505-510.
13. Kovar FM, Endler G, Wagner OF, et al. Basal haemoglobin levels as prognostic factor for early death in elderly patients with a hip fracture—A twenty year observation study. Injury, 2015, 46(6): 1018-1022.
14. Fowler AJ, Ahmad T, Phull MK, et al. Meta-analysis of the association between preoperative anaemia and mortality after surgery. Br J Surg, 2015, 102(11): 1314-1324.
15. Gupta BP, Huddleston JM, Kirkland LL, et al. Clinical presentation and outcome of perioperative myocardial infarction in the very elderly following hip fracture surgery. J Hosp Med, 2012, 7(9): 713-716.
16. 王振恒, 方永超, 阚翔翔, 等. 影响老年髋部骨折患者术后 1 年死亡率的因素分析. 中国矫形外科杂志, 2014, 22(2): 110-114.
17. Lu J, Chen YY, Zhang L, et al. Laboratory nutritional parameters predict one-year mortality in elderly patients with intertrochanteric fracture. Asia Pac J Clin Nutr, 2016, 25(3): 457-463.
18. Bhaskar D, Parker MJ. Haematological indices as surrogate markers of factors affecting mortality after hip fracture. Injury, 2011, 42(2): 178-182.
19. Khan SK, Kalra S, Khanna A, et al. Timing of surgery for hip fractures: a systematic review of 52 published studies involving 291, 413 patients. Injury, 2009, 40(7): 692-697.
20. Moja L, Piatti A, Pecoraro V, et al. Timing matters in hip fracture surgery: patients operated within 48 hours have better outcomes. A meta-analysis and meta-regression of over 190, 000 patients. PLoS One, 2012, 7(10): e46175.
21. Novack V, Jotkowitz A, Etzion O, et al. Does delay in surgery after hip fracture lead to worse outcomes? A multicenter survey. Int J Qual Health Care, 2007, 19(3): 170-176.
22. Shiga T, Wajima Z, Ohe Y. Is operative delay associated with increased mortality of hip fracture patients? Systematic review, meta-analysis, and meta-regression. Can J Anaesth, 2008, 55(3): 146-154.
23. Tulic G, Dubljanin-Raspopovic E, Tomanovic-Vujadinovic S, et al. Prolonged pre-operative hospital stay as a predictive factor for early outcomes and mortality after geriatric hip fracture surgery: a single institution open prospective cohort study. Int Orthop, 2018, 42(1): 25-31.
24. 王晓伟, 何红英, 张建政, 等. 老年髋部骨折术后长期病死率及相关危险因素分析. 中华创伤骨科杂志, 2018, 20(9): 763-767.
25. Cornwall R, Gilbert MS, Koval KJ, et al. Functional outcomes and mortality vary among different types of hip fractures: a function of patient characteristics. Clin Orthop Relat Res, 2004, (425): 64-71.
26. 戴兵, 骆洪涛, 孟祥德, 等. 骨折类型与老年髋部骨折术后疗效分析. 中华临床医师杂志(电子版), 2010, 4(5): 630-634.

Chinese Journal of Reparative and Reconstructive Surgery

Risk factors analysis for postoperative mortality of elder patients with intertrochanteric fractures

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