MORTALITY IN PATIENTS > 90 YEARS OLD WITH PROXIMAL FEMORAL FRACTURES SUBJECTED TO SURGERY

ABSTRACT Introduction: Proximal femoral fractures have a high mortality rate among older adults, especially those aged > 80 years. Objective: To analyze predictive factors for hospital or late mortality of patients > 90 years old who showed proximal femoral fracture and subjected to surgery. Methods: The study included data from 230 patients aged > 90 years diagnosed with proximal femoral fracture and who underwent surgery between January and December 2017. The statistical evaluation was performed by multivariate analysis by a logistic regression. The associations were estimated by the odds ratio (OD) and confidence interval (95%). Statistical significance was determined with p < 0.05. Results: Late death occurred in 51.3% (118 patients) of the sample and hospital death in 3.5% (8 patients). Most patients were women (83.5%) and the most common fracture was transtrochanteric (57.0%). There was association between late death and the surgery duration (p < 0.05), and between hospital death and the presence of heart diseases (p < 0.05) or endocrinopathies (p < 0.05). Conclusion: Most patients aged > 90 years with proximal femoral fracture subjected to surgery died in less than one year. Late death was associated with the surgery duration and hospital death was associated with the presence of previous endocrinopathies or heart diseases, and the female gender was a protective factor from this outcome. Level of Evidence III, Retrospective Case-Control Study.

摘要
引言：在老年人群，尤其是80岁以上群体中，股骨近端骨折（proximal femoral fracture）的死亡率居高不下。
目的：分析90岁以上接受手术治疗的股骨近端骨折患者的院内死亡及远期死亡预测因素。
方法：本研究纳入2017年1月至12月期间收治的230例90岁以上确诊为股骨近端骨折并接受手术治疗的患者数据。采用Logistic回归（logistic regression）多因素分析进行统计学评估，以优势比（odds ratio，原文缩写OD）及95%置信区间（95%CI）估算变量间的关联强度，以P<0.05作为统计学显著性判定标准。
结果：本研究样本中，51.3%（118例）患者发生远期死亡，3.5%（8例）发生院内死亡。受试者中女性占比83.5%，最常见的骨折类型为转子间骨折（transtrochanteric fracture），占比57.0%。远期死亡与手术时长存在统计学关联（P<0.05）；院内死亡则与心脏病史（P<0.05）或内分泌疾病（endocrinopathies）史（P<0.05）相关。
结论：90岁以上接受手术治疗的股骨近端骨折患者中，多数在术后1年内死亡。远期死亡与手术时长相关，院内死亡与既往内分泌疾病或心脏病史相关，而女性为该结局的保护因素。
证据等级：Ⅲ级，回顾性病例对照研究。