| BackgroundHip fracture is a common type of fracture in the elderly,and the incidence rate is increasing with the 1%~3% rate.The first choice of clinical treatment of hip fracture in China is surgical treatment,but the elderly patients often combined with a variety of chronic diseases,various organs compensatory ability is low,postoperative complications of the incidence and death rate is high.Therefore,it is necessary to evaluate the perioperative risk of older patients with hip fracture.However,surgical risk assessment tools,such as the United States acute physiology and chronic health scoring system,the National Association of Narcotic Physicians score.Most of these risk assessment tools are used in a single specialist disease and are more complex,time-consuming,consuming,and not included in the old age syndrome in the use process.With the development of perioperative patient assessment methods,the latest development of surgical evaluation suggested that the patient's physiological state could affect the postoperative outcome more than the operation.The physical state of the elderly patient itself can be used to "frailty" to represent.Therefore,the frailty assessment can be used as a tool to evaluate the risk of surgery and predict the adverse health outcomes of elderly patients.frailty involves a variety of systemic physiological changes,including neuromuscular systems,metabolic and immune system changes,which refer to a nonspecific state in which the body's physical reserve decreases and the body's vulnerability increases and the ability to resist stress decreases.Both China and the US group of experts have recommended that frailty should be included in the guidelines for optimizing preoperative evaluation of elderly patients undergoing surgery.The frailty Index is the main assessment tool for assessing frailty,and Drs.Rockwood and Mitnitski believe that frailty is the result of a cumulative health defect,creating a weak index based on the cumulative theory of defects.FI refers to the prevalence of health defects in the elderly as a proportion of all measurement variables,the definition method does not rely on specific variables,a variety of complex health information with a simple mathematical model to integrate into a single index,can better reflect the overall health of the body.Studies show that FI is superior to the National Association of Physicians in predicting outcomes.FI,as a comprehensive score superior to other preoperative evaluation tools can be used for preoperative evaluation of patients with physiological reserve and risk stratification.FI is widely used to predict the surgical complications of colon,liver,heart and hip fractures,while domestic research is only used in elderly health assessment,senile nodular goiter,prostate hyperplasia.Therefore,there is still a lack of research on the relationship between frailty index and the risk of senile hip fracture surgery.ObjectivesThis study uses his system to extract the clinical information to construct the frailty index,to explore the predictive effect of the frailty index on the perioperative risk of older hip fracture,and to provide an important reference for perioperative comprehensive intervention decision and prognostic evaluation of older hip fracture patients.Samples and MethodsA database of older hip fracture was established by collecting the old hip fracture in the hospitalized Department of Sichuan Huaxi Hospital from December 7,2010 to June 14,2017.In strict accordance with the inclusion criteria and exclusion criteria of this study,965 cases of older perioperative study were screened out.Age,sex,marital status,smoking,alcohol,current history,physical examination,chronic diseases,postoperative complications and hospitalization expenses were collected from the database.According to the principles of the international establishment of the frailty index,33 variables are constructed from the symptom,physical examination and chronic disease of the patient to construct the frailty index.The formula for the frailty index(FI)is: Total number of variables with health defects in /total number of variables considered as health defect items(n=33).In this study,the FI value greater than or equal to 0.21 was considered frailty,less than 0.21 as robust.We design EXCEL forms to extract data and use SPSS 22.0 statistical software packages for statistical analysis(IBM Corp.,Somers,NY).The statistical description adopts the mean-± standard deviation,four-point number or percentage,according to the comparison between the data types,T test,Card square test,Mann-whitney U,Kruskal-wallis test,Wilcoxon rank and test method.Multi-Factor analysis was performed using two-or ordered logistic regression to correct the correlated confounding factors.All analysis,bilateral P value is less than 0.05 considered statistically significant.Results1.In 965 patients with older hip fracture,126 cases(13.1%)were frailty,and 839 cases(86.9%)were robust.In the frailty group,35(27.8%)cases were men,91(72.2%)cases were female.In the robust group,293 cases(34.9%)were male and 546 were female(65.1%).In frailty group and robust group,the incidence of complication was 34.1% VS 20.3%,the severity of postoperative complications graded level I was 11.1% vs 7.5%,II level 23.0% vs 11.4%,III level and above 4.0% vs 3.3%.Incision Healing grade B and above for 7.1% VS 3%.Lung infection for 20.6% VS 11.1%,Low protein blood was 9.5% vs 4.5%,anemia was 13.5% vs 8.1%.The results of chi-square test showed that the incidence of complications,severity grading of postoperative complications,incision healing grade,pulmonary infection,low protein blood and anemia in frailty hip fracture group were statistically significant compared with those in the robust group(p<0.05).2.After two yuan or orderly logistic regression analysis,correcting the correlated confounding factors such as age,sex,marriage,smoking,drinking and so on,the results showed that the risk of postoperative complications was greater(or:2.018;95%ci:1.343 ~ 3.031)in frailty hip fracture group compared with the the robust group.The severity level of postoperative complications was higher(or:2.08;95%ci:1.41~3.06),postoperative incision delayed Union(or:2.546;95%ci:1.148~5.648)and pulmonary infection(or:2.098;95%ci:1.289 ~ 3.414)and low protein Blood syndrome(or:2.23;95%ci:1.127~4.413).3.In the older patients with hip fracture,the hospitalization cost in the frailty group mean(p25,p75)was 46492.57(37826.95,57674.69)and 41886.66(35025.04,51690.75).in the robust group.The results of rank and test showed that there was a statistically significant difference between hospitalization expenses and frailty index(z=3.622,p=0.000).Spearman correlation coefficient R was 0.117(P<0.001),which indicated that the frailty state of hip fracture was positively correlated with hospitalization expenses.ConclusionThe incidence of postoperative complications was higher in senile patients with hip fracture,and the FI was significantly correlated with adverse outcome after hip fracture,including severity score of postoperative complication,pulmonary infection,low blood protein,incision healing grade and hospitalization expenses.Preoperative evaluation of the frailty index can help clinicians to make preoperative decision for the elderly patients with hip fracture,thus reducing postoperative complications and reducing hospitalization expenses.However,there is no study on the frailty index and hip fracture in China,this study confirms that the frailty index can provide predictive effect for the adverse outcome of older hip fracture,and it is very important for clinical treatment. |
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