Background

Fragility hip fractures are a common orthopedic injury seen in Emergency Departments, with variable outcomes that can range from average to devastating. Currently, few reliable metrics to predict which patients will suffer post-operative complications exist. The aim of this study was to determine if the number and type of pre-operative medications can help predict post-operative complications.

Methods

A prospectively collected database of hip fracture patients was retrospectively reviewed. Patients with isolated greater trochanteric fractures, periprosthetic fractures, or re-fractures were excluded. Pre-operative baseline characteristics as well as number and type of post-operative complications were reviewed. Any complication within 6 months of surgery and complications that could be directly attributable to the surgical procedure within 2 years of surgery were examined. Major complications (return to the operating room, deep infection, pulmonary, cardiac, and hematologic) and minor medical complications were assessed. A multivariate regression model was performed to identify independent risk factors.

Results

Three-hundred ninety-one patients were included. A majority were aged 80–90 and female, and lived at home prior to presentation. Overall, 33.7% of patients suffered a complication within a 2-year follow-up period. Mortality rates were 5.4%, 10.0%, and 14.9% over 30 days, 1 year, and 2 years, respectively. After assessing this relationship while controlling for age, sex, injury type, pre-operative residence, ambulatory status, ASA score, and CCI score, the relationship remained significant for both an increased number of complications (P = .048) and a higher likelihood of having a complication (P = .008). Cardiovascular (P = .003), pulmonary (P = .001), gout (P = .002), or diabetes (P = .042) medications were associated with a higher likelihood for experiencing a complication.

Conclusions

Our study suggests that there is a strong and linear relationship between the number and type of pre-operative medications taken and risk of post-operative complications. This exists for up to 8 medications, at which point further increase does not contribute to an increased risk of complication. This relationship exists even after controlling for confounding variables and can be used by surgeons to better counsel patients and families regarding their specific risk for suffering perioperative complications.

中文翻译：

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术前药物作为老年髋部骨折手术术后并发症的预测指标

背景

脆性髋部骨折是急诊科常见的骨科损伤，其后果从平均到毁灭性不等。目前，几乎没有可靠的指标来预测哪些患者将遭受术后并发症。本研究的目的是确定术前药物的数量和类型是否有助于预测术后并发症。

方法

回顾性回顾了前瞻性收集的髋部骨折患者数据库。排除孤立性大转子骨折、假体周围骨折或再骨折的患者。审查了术前基线特征以及术后并发症的数量和类型。检查了手术后 6 个月内的任何并发症以及手术后 2 年内可直接归因于手术程序的并发症。评估了主要并发症（返回手术室、深部感染、肺部、心脏和血液系统）和轻微的医疗并发症。进行多变量回归模型以识别独立的危险因素。

结果

包括三百九十一名患者。大多数年龄在 80-90 岁之间的女性，在介绍之前住在家里。总体而言，33.7% 的患者在 2 年的随访期内出现并发症。30 天、1 年和 2 年的死亡率分别为 5.4%、10.0% 和 14.9%。在控制年龄、性别、损伤类型、术前居住地、行走状态、ASA 评分和 CCI 评分的同时评估这种关系后，对于并发症数量的增加 ( P = .048) 和更高的可能性，这种关系仍然显着有并发症（P = .008）。心血管 ( P = .003)、肺 ( P = .001)、痛风 ( P = .002) 或糖尿病 ( P= .042) 药物与出现并发症的可能性更高有关。

结论

我们的研究表明，术前服用药物的数量和类型与术后并发症的风险之间存在很强的线性关系。这存在于多达 8 种药物中，此时进一步增加不会增加并发症的风险。即使在控制了混杂变量之后，这种关系仍然存在，并且可以被外科医生用来更好地为患者和家属提供关于他们患围手术期并发症的具体风险的咨询。