Risk Factors For Perioperative Death And Severe Complications Following Geriatric Hip Fracture Surgery

Objective:To analyze the risk factors for perioperative death and severe complications following hip fracture surgery in geriatric patients,and to provide reference for perioperative management and realizing enhanced recovery after surgery.Methods:The geriatric hip fracture patients at the Affiliated Hospital of Hebei University from January 2015 to December 2019 were analyzed retrospectively.The inclusion criteria included aged≥65 years,hip fracture with the defined ICD-10 code(including femoral neck fracture,intertrochanteric fracture and subtrochanteric fracture)and operative treatment.Exclusion criteria for this study included high energy injury and incomplete data.We collected clinical data of all cases,including:demographic date,comorbidities,preoperative laboratory tests and operation related information,and explored the clinical characteristics of the geriatric hip fracture patients.Univariate and multivariate analyses were carried out to identify risk factors for perioperative death and severe complications.Results:1.A total of 762 cases of geriatric hip fracture were analyzed in this study.All patients had an average age of 77.07±7.17 years(range 65-97 years).In total,260(34.12%)patients were male and 502(65.88%)patients were female.The mean Body Mass Index(BMI)was23.64±3.63 kg/m~2(range 13.3-37.5 kg/m~2).Among those patients,237(31.10%)patients had one comorbidity,223(29.27%)patients had two comorbidities,and 114(14.96%)patients had three or more comorbidities.The mean waiting time before admission was 50.50±82.43hours.The incidence of hypoproteinemia and anemia before surgery in individuals with hip fracture were 32.94%and 29.92%.Of the fractures,339 were femoral neck fracture(44.49%),411 were intertrochanteric fracture(53.94%),and 12 were subtrochanteric fracture(1.57%).When the patients were assessed according to American Society of Anesthesiologists(ASA)score,335(43.96%)patients with ASAⅠ～Ⅱ,and 427(56.04%)patients with ASAⅢ～Ⅳ.The mean time to surgery was 118.14±71.46 h.This study included 488(64.04%)cases of general anesthesia and 274(35.96%)cases of intravertebral anesthesia.There were 57.74%of patients with internal fixation,31.50%of patients with hemiarthroplasty,and 10.76%of patients with total hip arthroplasty.The mean duration of surgery was 94.19±44.26 minutens,and the mean postoperative length of stay was 11.5 days.2.After screening,79(10.37%)patients had death or severe complications after hip fracture surgery,including 2 deaths,5 neurological complications,51 pulmonary infections,18 cardiovascular complications,and 19 Deep Vein Thrombosis(DVT)/Pulmonary Embolism(PE).Univariate analysis showed that risk factors affecting the occurrence of perioperative pulmonary infection included age adjusted Charlson comorbidity index(ACCI)(P=0.006),hypoproteinemia(P=0.002),anemia(P<0.001),and ASAⅢ～Ⅳ(P=0.030).The multivariate analysis showed that hypoproteinemia(OR=1.852,P=0.045)and anemia(OR=2.186,P=0.011)were independent risk factors for perioperative pulmonary infection.Conclusion:1.The geriatric hip fracture patients are more common in females,and they often have pre-existing comorbids.It should be paid attention to admission delay and surgery delay.2.Perioperative pulmonary infection is the result of multiple factors,hypoproteinemia and anemia are independent risk factors for perioperative pulmonary infection.