Risk Factors Analysis For Postoperative Mortality In The Elderly Patients With Femoral Neck Fracture

Objective: To calculate the postoperative mortality in the elderly patients with femoral neck fracture after artificial femoral head arthroplasty,and statistically analyze the risk factors of the postoperative mortality.Methods: According to the inclusion and exclusion standards,the clinical data of patients with femoral neck fracture treated with artificial femoral head arthroplasty,aged 65 years or older admitted to Zhongda Hospital Affiliated to Southeast University from January 2011 to December 2015 were collected,mainly including age,gender,clinical diagnosis,admission time,operation time,comorbidity and preoperative laboratory nutritional parameters.Patients were followed up for 2 years after operation,their survival and outcomes data were recorded.Using statistical software,Chi-squared test and Cox proportional hazard model were performed to analyze the risk factors of postoperative mortality in elderly patients with femoral neck fracture.Results: The majority of the 109 patients included in the study were female patients(70.6%),with an average age of 83.6±6.5 years,elderly patients aged 380 years accounting for 73.4%,complications mainly including hypertension(52.3%),cerebral infarction(35.8%),diabetes(24.8%),and chronic obstructive pulmonary disease(2.8%),43.2% of the patients with two or more comorbidities,and 34.7% of the patients considered malnourished.During the two years follow up,the 1-year and 2-year mortality were 6.4% and 17.4%,respectively.Univariate analysis showed that the 1-year mortality in the elderly patients with femoral neck fracture after artificial femoral head arthroplasty was related to serum albumin and nutritional status.The mortality of patients with serum albumin <35 g/L was higher than that of patients with serum albumin ?35 g/L.The mortality of malnourished patients was higher than that of non-malnourished patients.The 2-year mortality in the elderly patients with femoral neck fracture after artificial femoral head arthroplasty was related to age,chronic obstructive pulmonary disease,serum albumin,hemoglobin,and nutritional status.Cox proportional hazard regression model analysis showed that chronic obstructive pulmonary disease(P<0.001),low hemoglobin level(P=0.034)and malnutrition(P=0.003)were risk factors of the postoperative mortality.The risk of postoperative death in patients with chronic obstructive pulmonary disease was 18.192 times that of patients without chronic obstructive pulmonary disease.The risk of postoperative death in patients with low hemoglobin level was 3.455 times that of patients with normal hemoglobin.The risk of postoperative death in patients with malnutrition was 4.534 times that of non-malnourished patients.Conclusion: The elderly patients with femoral neck fracture treated with artificial femoral head arthroplasty are more common in women,the majority of whom are the advanced aged patients.Malnutrition is the risk factors for 1-year mortality of the elderly patients with femoral neck fracture after artificial femoral head arthroplasty.Chronic obstructive pulmonary disease,low hemoglobin and malnutrition are the risk factors for postoperative mortality of the elderly patients with femoral neck fracture after artificial femoral head arthroplasty.