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.
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