Impact of preoperative cognitive dysfunction on the prognosis of hip fractures in the elderly
Objective To explore the correlation between preoperative cognitive dysfunction and postopera-tive mortality and functional outcomes in the elderly with hip fractures.Methods A post hoc analysis was used to analyze 1 092 prospectively collected geriatric hip fractures(over 65 years of age),who were admitted to Beijing Jishuitan Hospital from Nov.2018 to Nov.2019.Patients were divided into a cognitively impaired group and a cog-nitively normal group based on the score of the preoperative Mini Mental State Examination(MMSE).All patients were followed up by telephone for 3-4(mean 3.5)years,to evaluate death events and exact time,patients'quality of life and mobility outcomes by the EuroQol Five Dimensions Questionnaire(EQ-5D)and Parker Mobility Rating Scale.Intergroup comparisons,multifactorial Cox regression survival analysis,and survival curves were used to com-pare the differences between the two groups and to analyze the effect of cognitive impairment.Results Altogether 871 elderly hip fracture patients were finally included in this study,including 374(107 males and 267 females aged of 65-98 years,mean 79.9 years)in the cognitively impaired group,and 497(151 males and 346 females aged 65-101 years,mean 79.4 years)in the cognitively normal group.The mortality rate in the cognitively impaired group was 25.7％(96/374),which was significantly higher than that in the cognitively normal group(18.9％,94/497,P=0.017);moreover,the mean survival time(days)in the cognitively impaired group(1138.3±20.2)was shorter than that in the cognitively normal group(1193.5±15.4).Even after correcting potential covariates of age,sex,hy-pertension,diabetes,stroke,coronary artery disease,surgical approach,and length of hospitalization,the association between cognitive dysfunction and the risk of death at 3-4 years postoperatively remained statistically significant(HR 1.386,95％CI 1.039-1.849,P=0.027).Regarding functional outcomes,both the Parker score(Z=2.802,P=0.005)and the EQ-5D score(Z=2.725,P=0.006)were lower in the cognitively impaired group than in the cogni-tively normal group,suggesting that the patients with comorbid cognitive dysfunction had poorer long-term mobility and quality of life.Conclusion Elderly hip fracture patients with preoperative comorbid cognitive dysfunction have significantly higher mortality and worse quality of life and mobility at 3-4 years.
万方数据
维普
