Risk factors for one-year mortality in elderly patients with femoral intertrochanteric fracture following multidisciplinary treatment by intramedullary nailing
10.3760/cma.j.cn115530-20220304-00127
- VernacularTitle:多学科协作诊疗模式下老年股骨转子间骨折患者髓内钉固定术后1年死亡的危险因素分析
- Author:
Liyong BAI
1
;
Tian XIE
;
Panpan LU
;
Yingjuan LI
;
Xiangxu CHEN
;
Yuanwei ZHANG
;
Liu SHI
;
Jihong ZOU
;
Liqun REN
;
Xiaodong QIU
;
Jie SUN
;
Ying CUI
;
Hui CHEN
;
Hao WANG
;
Yakuan ZHAO
;
Chuwei TIAN
;
Yunfeng RUI
Author Information
1. 东南大学附属中大医院骨科、创伤救治中心，东南大学创伤骨科研究所，南京 210009
- Keywords:
Hip fractures;
Fracture fixation, intramedullary;
Death;
Risk factor;
Multidisciplinary team;
Aged
- From:
Chinese Journal of Orthopaedic Trauma
2022;24(9):779-785
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To analyze the risk factors for postoperative one-year mortality in elderly patients with femoral intertrochanteric fracture following multidisciplinary treatment (MDT) by intramedullary nailing.Methods:The clinical data were retrospectively analyzed of the 158 elderly patients with femoral intertrochanteric fracture who had undergone MDT by proximal femoral intramedullary nailing between January 2018 and August 2020 at Department of Orthopedics, Trauma Center, Zhongda Hospital Affiliated to Southeast University. There were 41 males and 117 females with an average age of 82.5 years (from 65 to 95 years). By the modified Evans classification, there were 15 cases of type Ⅰ, 16 cases of type Ⅱ, 35 cases of type Ⅲ, 81 cases of type Ⅳ, and 11 cases of type Ⅴ. The one-year mortality was documented in the patients after surgery. To screen for risk factors, univariate analysis was conducted of gender, age, body mass index (BMI), modified Evans classification of fractures, time from injury to operation, American Society of Anesthesiologists (ASA) classification, Charlson comorbidity index (CCI) and comorbidities, as well as preoperative hemoglobin (Hb), serum albumin (ALB) and total lymphocyte count (TLC). The factors with P<0.05 were included in the multivariate logistic regression model analysis to determine the risk factors. Results:A total of 13 patients died within one year after surgery, yielding a mortality of 8.2% (13/158). Univariate analysis showed significant differences in age, body mass index, modified Evans classification of fractures, CCI and Hb between the surviving and dead patients ( P<0.05). Multivariate logistic regression analysis showed that age >85 years ( OR=0.122, 95% CI: 0.018 to 0.834, P=0.032), BMI>23.9 kg/m 2 ( OR=0.083, 95% CI: 0.013 to 0.510, P=0.007), CCI≥3 points ( OR=0.051, 95% CI: 0.090 to 0.275, P=0.001) and preoperative Hb<90 g/L ( OR=4.733, 95% CI: 1.036 to 21.624, P=0.045) were the independent risk factors for postoperative one-year mortality in the elderly patients with intertrochanteric fracture following MDT by proximal femoral intramedullary nailing. Conclusions:After MDT by proximal femoral intramedullary nailing of femoral intertrochanteric fractures, the geriatric patients with an age >85 years, BMI>23.9 kg/m 2, CCI≥3 points and Hb<90 g/L are likely to die. Therefore, special care should be taken for them.
