改良衰弱指数-5对老年髋部骨折患者术后并发症及死亡率的影响
The value of the modified 5-factor frailty index in assessing postoperative complications and mortality in elderly patients with hip fractures
谢宗燕 1张书瑜 2王旭红 1郭俊荣 1奚健 1赵飞飞 3金璐 3刘亮4
作者信息
- 1. 首都医科大学附属北京潞河医院临床药理科,北京 101100
- 2. 南昌大学医学院,南昌 330031
- 3. 首都医科大学附属北京潞河医院循证医学中心,北京 101100
- 4. 首都医科大学附属北京潞河医院骨中心,北京 101100
- 折叠
摘要
目的 探讨改良衰弱指数-5对老年髋部骨折患者术后并发症及死亡率的影响.方法 回顾性研究,收集在首都医科大学附属北京潞河医院2015年1月至2019年12月诊治的60岁及以上髋部骨折手术患者的临床资料,根据改良衰弱指数评分分为≤1分和≥2分组,并对术后30 d、1年、2年、4年的存活情况进行随访,采用Kaplan-Meier法进行术后生存分析,多因素Cox回归分析影响老年患者死亡的相关因素.结果 共纳入1 208例患者,评分≤1分组890例、评分≥2分组318例,两组30 d死亡率、1年死亡率、2年死亡率和4年死亡率分别为1.6％(14/890)比1.9％(6/318)(P=0.707)、11.3％(99/874)比 11.6％(36/310)(P=0.917)、19.7％(168/852)比 24.3％(73/300)(P=0.099)、44.0％(238/541)比 51.5％(106/206)(P=0.071),差异均无统计学意义.评分≥2分组的术后并发症发生率较评分≤1分组高[14.8％(47/318)比9.7％(86/890)(P=0.012)],其中脑卒中发生率为6.3％(20/318)比1.8％(16/890)(P＜0.001)、术后肺炎发生率为6.0％(19/318)比3.1％(28/890)(P=0.029),两组差异均有统计学意义.多因素Cox回归分析结果显示,年龄、女性、Charlson合并症指数评分以及入院时血红蛋白偏低均是术后患者1年、2年、4年死亡的独立危险因素(均P＜0.05),而改良衰弱指数评分则不是术后死亡的独立危险因素.结论 改良衰弱指数评分≥2分可预测髋部骨折患者术后肺炎和脑卒中的发生风险,但并未发现与术后死亡风险有关.
Abstract
Objective To analyze the value of the modified 5-factor frailty index in assessing postoperative complications and mortality in elderly hip fracture patients.Methods In this retrospective study,clinical data were collected of hip fracture patients aged 60 years and above surgically treated at Beijing Luhe Hospital affiliated to Capital Medical University between January 2015 and December 2019.Patients'group assignment was based on whether the modified frailty index score was ≤1 or ≥2,and a post-surgery follow-up was conducted for survival at 30 days,1 year,2 years,and 4 years,which was analyzed by the Kaplan-Meier method.Multivariate Cox regression analysis was used to identify factors affecting death in elderly patients.Results A total of 1 208 patients were included,with 890 in the group with the index score ≤1 and 318 in the group with the index score ≥2.There was no difference in mortality at 30 days(1.6％or 14/890 vs.1.9％or 6/318,P=0.707),1-year(11.3％or 99/874 vs.11.6％or 36/310,P=0.917),2-years(19.7％or 168/852 vs.24.3％or 73/300,P=0.099)and 4-years(44.0％or 238/541 vs.51.5％or 106/206,P=0.071).The incidence of postoperative complications in the group with the score ≥2 was higher(14.8％or 47/318 vs.9.7％or 86/890,P=0.012),including the incidence of stroke(6.3％or 20/318 vs.1.8％or 16/890,P＜0.001)and the incidence of postoperative pneumonia(6.0％or 19/318 vs.3.1％or 28/890,P=0.029),and the differences were statistically significant.Multivariate Cox regression analysis showed that age,being female,the Charlson comorbidity index score and low hemoglobin at admission were risk factors for 1-year,2-year and 4-year mortality post-surgery(all P＜0.05),while the modified frailty index score had no correlation with postoperative mortality.Conclusions A modified frailty index ≥2 is predictive of increased risk of postoperative pneumonia and stroke in patients with hip fractures,but is not correlated with the risk of postoperative mortality.
关键词
髋骨折/虚弱老人/手术后并发症/死亡率/改良衰弱指数-5Key words
Hip fractures/Frail elderly/Postoperative complications/Mortality/Modified 5-factor frailty index引用本文复制引用
基金项目
首都卫生发展科研专项(首发2020-2-7081)
出版年
2024
NETL
NSTL
维普
万方数据