Analysis of factors affecting the discharge outcomes of inpatients with fractures
Objective To explore the influencing factors of clinical outcomes of inpatients with fractures when they were discharged from hospitals.Methods Clinical data of fracture patients hospitalized in the Depart-ment of Orthopaedic Trauma,Tangdu Hospital were analyzed retrospectively from Jan.2012 to Dec.2021.Patients were divided into cured group(n=9811)and non-cured group(n=5143),according to the clinical outcome(medi-cal record)at the time of discharge.The age,sex,occupation,place of residence,marital status,fracture season,fracture place,fracture cause,mode of admission,general condition on admission,fracture location and type,mode of treatment,days of hospitalization,combined injuries and underlying diseases were compared between the two groups.Multivariate logistics regression was further adopted to analyze the independent influencing factors.Results It was found that the factors of age,marital status,occupation,place of residence,fracture place and cause,mode of admis-sion,general condition on admission,fracture location,surgical treatment,days of hospitalization,combined injuries and basic diseases were significantly correlated with the discharge outcomes of inpatients with fractures(all P<0.05),except for sex,fracture type and fracture season(all P>0.05).Multivariate logistic regression analysis sug-gested the following favorable factors for a cured fracture at hospital discharge:stable general condition on admission(OR=1.260,95%CI:1.137-1396),hand or wrist fractures(OR=1.234,95%CI:1.005-1.516),hip or thigh frac-tures(OR=1.212,95%CI:1.056-1.390),closed fractures(OR=1.559,95%CI:1.392-1.746)and surgical treat-ment(OR=24.099,95%CI:21.071-27.561);and unfavorable factors of uncertain fracture causes(OR=0.646,95%CI:0.503-0.828),spine fractures(OR=0.708,95%CI:0.545-0.920),pelvis fractures(OR=0.752,95%CI:0.597-0.947),long hospital stay(OR=0.995,95%CI:0.993-0.998),and combined with other injuries(OR=0.740,95%CI:0.675-0.812)or underlying diseases(OR=0.757,95%CI:0.676-0.848).Conclusion For frac-ture patients in critical condition on admission,fractures involving the spine or pelvic,combined with other injuries,or having underlying diseases,individualized treatment and care should be given to increase the chance of clinical cure at the time of discharge.In addition,surgical treatment shows a significantly higher clinical cured rate;howev-er,surgeries may lead to complications such as bone nonunion,and thus the surgical indications should be strictly grasped in the treatment of inpatients with fractures.
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