Efficacy of surgical intervention over conservative management in intertrochanteric fractures among nonagenarians and centenarians: a prospective cohort study

医学 倾向得分匹配 队列 列线图 前瞻性队列研究 比例危险模型 逻辑回归 危险系数 人口 队列研究 外科 置信区间 内科学 环境卫生
作者
Junfei Guo,Xin Xu,Geng Qian,Tao Wang,Ke Xu,Jinwen He,Yubin Long,Qi Zhang,Wensen Jing,Zheng Li,Ying Pan,Peng Xu,Zhiyong Hou
出处
期刊:International Journal of Surgery [Wolters Kluwer]
被引量:8
标识
DOI:10.1097/js9.0000000000001143
摘要

Background: Optimal treatment strategy for nonagenarians and centenarians with hip fractures (NCHF) remained unknown. We aimed to compare the outcomes of surgical and conservative management in NCHF. Methods: A prospective cohort study was conducted based on CPMHF database with NCHF patients hospitalized during 2014–2020. Comorbidities were evaluated by mECM score and restricted cubic spline was utilized to visually assess the dose-effect relationship between the mECM and outcomes. Propensity score matching was performed to balance baseline characteristics between non-surgical and surgical groups. Multivariate logistic regression, Cox proportional hazard analysis, and survival analysis were employed for unfavorable outcomes (UFO) evaluation. Competing risk of death were analyzed based on Fine and Gray’s hazard model and then constructed nomogram models for predicting survival rates. Subgroup analyses were used to determine potential population heterogeneity and sensitivity analyses were performed to test robustness of the results. Results: We found increasing trends for UFO with the increase in the mECM score, and that high mECM score (HMS, ≥3) was independently associated with a 2.42-fold (95%CI, 2.07-3.54; P =0.024) increased risk of UFO, which remained significant after considering the competing role of death and were more pronounced in non-surgical treatment, women, no insurance, and patients with spouse (all P for interaction<0.05). Surgical intervention was identified to be significant protective factors for UFO (RR, 0.59; 95%CI, 0.46-0.75; P <0.001) and severe complications (RR, 0.63; 95%CI, 0.41-0.96; P =0.033) after PSM, as well as survival (HR, 0.40, 95%CI, 0.28-0.58; P <0.001), which remained significant after considering the competing role of death and in all sensitivity analyses and were more pronounced in HMS participants ( P for interaction=0.006). Subgroup analyses revealed surgical patients with HMS had a significantly higher UFO rate (excluding death, P <0.001) while non-surgical patients with HMS had higher mortality rate as compared to the others ( P =0.005). Conclusion: Surgical treatment for NCHF yields better outcomes compared to conservative treatment.
最长约 10秒,即可获得该文献文件

科研通智能强力驱动
Strongly Powered by AbleSci AI
更新
PDF的下载单位、IP信息已删除 (2025-6-4)

科研通是完全免费的文献互助平台,具备全网最快的应助速度,最高的求助完成率。 对每一个文献求助,科研通都将尽心尽力,给求助人一个满意的交代。
实时播报
欧耶发布了新的文献求助10
1秒前
YY张完成签到,获得积分20
1秒前
3秒前
3秒前
Joyce完成签到,获得积分10
4秒前
万能图书馆应助悦耳昊强采纳,获得10
5秒前
5秒前
天真的不尤完成签到 ,获得积分10
6秒前
悄悄睡觉完成签到 ,获得积分10
7秒前
小仙女发布了新的文献求助30
7秒前
小晓发布了新的文献求助10
7秒前
8秒前
领导范儿应助无限飞丹采纳,获得10
8秒前
美好的秋烟完成签到,获得积分20
9秒前
9秒前
幸福大白发布了新的文献求助30
10秒前
哒哒哒发布了新的文献求助10
11秒前
悦耳昊强完成签到,获得积分20
16秒前
打打应助顺利紫山采纳,获得10
17秒前
CR7应助ZONG采纳,获得20
18秒前
可爱的函函应助77采纳,获得10
18秒前
科研通AI2S应助李健采纳,获得10
18秒前
研友_VZG7GZ应助科研通管家采纳,获得10
19秒前
19秒前
大模型应助科研通管家采纳,获得30
19秒前
YamDaamCaa应助科研通管家采纳,获得30
19秒前
慕青应助科研通管家采纳,获得10
19秒前
小蘑菇应助科研通管家采纳,获得10
19秒前
Ava应助科研通管家采纳,获得10
19秒前
CipherSage应助科研通管家采纳,获得10
20秒前
CipherSage应助科研通管家采纳,获得10
20秒前
CAOHOU应助科研通管家采纳,获得10
20秒前
搜集达人应助科研通管家采纳,获得10
20秒前
20秒前
lll完成签到 ,获得积分10
21秒前
yar给迅速蜻蜓的求助进行了留言
21秒前
沉默的无施完成签到,获得积分10
25秒前
25秒前
苦行僧完成签到,获得积分10
25秒前
胡六条完成签到,获得积分10
25秒前
高分求助中
A new approach to the extrapolation of accelerated life test data 1000
ACSM’s Guidelines for Exercise Testing and Prescription, 12th edition 500
‘Unruly’ Children: Historical Fieldnotes and Learning Morality in a Taiwan Village (New Departures in Anthropology) 400
Indomethacinのヒトにおける経皮吸収 400
Phylogenetic study of the order Polydesmida (Myriapoda: Diplopoda) 370
基于可调谐半导体激光吸收光谱技术泄漏气体检测系统的研究 350
Robot-supported joining of reinforcement textiles with one-sided sewing heads 320
热门求助领域 (近24小时)
化学 材料科学 医学 生物 工程类 有机化学 生物化学 物理 内科学 纳米技术 计算机科学 化学工程 复合材料 遗传学 基因 物理化学 催化作用 冶金 细胞生物学 免疫学
热门帖子
关注 科研通微信公众号,转发送积分 3989450
求助须知:如何正确求助?哪些是违规求助? 3531621
关于积分的说明 11254315
捐赠科研通 3270207
什么是DOI,文献DOI怎么找? 1804928
邀请新用户注册赠送积分活动 882105
科研通“疑难数据库(出版商)”最低求助积分说明 809176