Background: In elderly patients with hip fracture, the prevalence of severe aortic stenosis (valve area < 1 cm²) is close to 5%. Few studies have evaluated the prognostic role of aortic stenosis in hip fracture surgery and none has considered the effects of the postoperative setting (intensive care unit vs general ward) on clinical outcome.
Purpose: The aim of the present study was to evaluate the factors affecting mortality in patients with severe aortic stenosis undergoing surgery for hip fracture. We also evaluated whether postoperative monitoring in the intensive care unit may affect the prognosis in comparison to return to the general ward after surgery.
Patients and Methods: All 2274 patients referred for hip fracture to our tertiary teaching hospital between January 1 2015 and December 31 2019 were screened for the presence of severe aortic stenosis, defined by an aortic valve area < 1.0 cm².
Results: The study included 66 patients (27 males, 39 females) with a mean±SD age of 85± 7 years. The average time between trauma and surgery was 2.6± 3 days. The mean aortic valve area was 0.74± 0.15 cm². Seven patients died during hospitalization (10.4%). Diabetes, having two or more comorbidities, a low degree of autonomy, heart failure, history of coronary artery disease, atrial fibrillation, postoperative delirium and pulmonary hypertension were associated with poorer outcome. In logistic multivariate analysis, the number of diseases and values of pulmonary artery pressure were the only independent factors related to mortality. In hospital mortality (12 and 9%, respectively) and complication rates were not statistically different between patients referred to the intensive care unit for postoperative monitoring and patients returned to the general ward after surgery.
Conclusion: In patients undergoing hip fracture surgery, severe aortic stenosis is associated with high hospital mortality, and two or more comorbidities and pulmonary hypertension are associated with a worse prognosis. The postoperative setting (intensive care unit or general ward) does not affect outcome.



中文翻译：

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严重主动脉瓣狭窄的髋部骨折手术：影响死亡率的因素研究

背景：在老年髋部骨折患者中，严重主动脉瓣狭窄（瓣膜面积<1 cm ²）的患病率接近5%。很少有研究评估主动脉瓣狭窄在髋部骨折手术中的预后作用，也没有研究考虑术后环境（重症监护室与普通病房）对临床结果的影响。
目的：本研究的目的是评估影响髋部骨折手术的严重主动脉瓣狭窄患者死亡率的因素。我们还评估了与术后返回普通病房相比，重症监护室的术后监测是否会影响预后。
患者和方法：^{在 2015 年 1 月 1 日至 2019 年 12 月 31 日期间，所有 2274 名因髋部骨折转诊至我们三级教学医院的患者均接受了严重主动脉瓣狭窄（定义为主动脉瓣面积 < 1.0 cm 2}）的筛查。
结果：该研究包括 66 名患者（27 名男性，39 名女性），平均±SD 年龄为 85±7 岁。创伤和手术之间的平均时间为 2.6± 3 天。平均主动脉瓣面积为 0.74± 0.15 cm ². 7名患者在住院期间死亡（10.4%）。糖尿病、有两种或多种合并症、自主程度低、心力衰竭、冠状动脉疾病史、心房颤动、术后谵妄和肺动脉高压与较差的结果相关。在logistic多变量分析中，疾病数量和肺动脉压值是与死亡率相关的唯一独立因素。住院死亡率（分别为 12% 和 9%）和并发症发生率在转诊到重症监护病房进行术后监测的患者和术后返回普通病房的患者之间没有统计学差异。
结论：在接受髋部骨折手术的患者中，严重的主动脉瓣狭窄与高住院死亡率相关，两种或多种合并症和肺动脉高压与较差的预后相关。术后环境（重症监护室或普通病房）不影响结果。