Risk factors of in-hospital complications in elderly patients undergoing hip fracture surgery under the orthopedic-geriatric co-management model
Objective:This study aimed to investigate the impact of demographics,comorbidities,and perioperative characteristics on in-hospital complications in elderly patients undergoing hip fracture surgery under the orthopedic-geriatric co-management model.Methods:A total of 1 263 elderly patients who underwent hip fracture surgery under the orthopedic-geriatric co-management model between January 2019 and December 2019 were retrospectively enrolled.Data on demographics,comorbidities,perioperative characteristics and clinical outcomes,including the type,frequency,and incidence of in-hospital complications and mortality were collected.Differences in risk factors were assessed using t-tests or Wald chi-square analysis.Weighted logistic regression and sensitivity analyses were performed to control for all factors in the model to identify independent risk factors.Results:The mortality rate during hospitalization was 0.079%(1/1 263)and 39.75%(502/1 263)of patients developed at least one complication.Regression analysis identified the following independent risk factors for developing in-hospital complications:hypoalbuminemia(OR=2.603;95%CI=1.479-4.572;P=0.001),hemiarthroplasty(OR=1.992;95%CI=1.130-3.514;P=0.017),cardiac disease(including coronary artery disease,permanent atrial fibrillation,valvular disease,and cardiac insufficiency)(OR=1.617;95%CI=1.158-2.280;P=0.005),elevated Charlson comorbidity index(CCI)(per point increase,OR=1.191;95%CI=1.010-1.402;P=0.035),and increased preoperative waiting time(per hour increase,OR=1.002;95%CI=1.001-1.004;P=0.012).Conclusions:The incidence of in-hospital complications in elderly patients undergoing hip fracture surgery remains high under the orthopedic-geriatric co-management model.Risk factors including hypoalbuminemia,hemiarthroplasty,cardiac disease,elevated CCI,and increased preoperative waiting time all contribute to the increased risk of in-hospital complications.Optimizing the treatment process,including routine screening for hypoalbuminemia in elderly patients undergoing hip fracture surgery,improvement of hypoalbuminemia,and reduction of preoperative waiting time,may help reduce the incidence of in-hospital complications.
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