Summary

To determine urban–rural differences influencing mortality in patients with hip fracture in Colombian Andes Mountains over a 1-year period.

Purpose

To identify the urban–rural differences of sociodemographic variables, fracture-related characteristics, and preoperative and postoperative clinical factors associated with 1-year mortality in patients over 60 years old who underwent hip fracture surgery in the Andes Mountains.

Methods

A total of 126 patients with a fragility hip fracture during 2019–2020 were admitted to a tertiary care hospital. They were evaluated preoperatively and followed up until discharge. Those who survived were contacted by telephone at 1, 3, and 12 months. Univariate, bivariate, and Kaplan–Meier analyses with survival curves were performed. Relative risk was calculated with a 95% confidence interval.

Results

A total of 32.5% of the patients died within 1 year after surgery, with a significant difference between those who resided in rural areas (43.1%) and those who resided in urban areas (23.5%) (RR 1.70; 95% CI, 1.03 to 2.80, p = 0.036). In the multivariate analysis, anemia (hemoglobin level ≤ 9.0 g/dL during hospitalization) (RR 6.61; 95% CI, 1.49–29.37, p = 0.003), a blood transfusion requirement (RR 1.47; 95% CI, 1.07 to 2.01, p = 0.015), the type of fracture (subtrochanteric fracture (RR = 4.9, 95% CI = 1.418–16.943, p = 0.005)), and postoperative acute decompensation of chronic disease (RR 1.60; 95% CI, 1.01 to 2.53, p = 0.043) were found to be independent predictive factors of 1-year mortality after surgery.

Conclusions

There was a difference in 1-year mortality between patients from rural and urban areas. More studies must be conducted to determine whether rurality behaves as an independent risk factor or is related to other variables, such as the burden of comorbidities and in-hospital complications.

中文翻译：

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髋部骨折手术后一年死亡率：哥伦比亚安第斯山脉的城乡差异

概括

旨在确定 1 年期间影响哥伦比亚安第斯山脉髋部骨折患者死亡率的城乡差异。

目的

旨在确定与安第斯山脉 60 岁以上接受髋部骨折手术的患者 1 年死亡率相关的社会人口统计学变量、骨折相关特征以及术前和术后临床因素的城乡差异。

方法

2019-2020 年间，共有 126 名脆性髋部骨折患者被一家三级医院收治。他们在术前进行评估并随访至出院。幸存者在第 1、3 和 12 个月时通过电话联系。对生存曲线进行了单变量、双变量和 Kaplan-Meier 分析。使用 95% 置信区间计算相对风险。

结果

共有 32.5% 的患者在术后 1 年内死亡，居住在农村地区的患者 (43.1%) 与居住在城市地区的患者 (23.5%) 之间存在显着差异（RR 1.70；95% CI，1.03到 2.80，p  = 0.036）。在多变量分析中，贫血（住院期间血红蛋白水平 ≤ 9.0 g/dL）（RR 6.61；95% CI，1.49–29.37，p  = 0.003），需要输血（RR 1.47；95% CI，1.07 至 2.01，p  = 0.015）、骨折类型（转子下骨折（RR = 4.9，95% CI = 1.418–16.943，p  = 0.005））和术后慢性疾病急性失代偿（RR 1.60；95% CI，1.01 至 2.53，p = 0.043) 被发现是术后 1 年死亡率的独立预测因素。

结论

农村和城市地区患者的 1 年死亡率存在差异。必须进行更多的研究来确定农村是作为一个独立的风险因素还是与其他变量有关，例如合并症和住院并发症的负担。