Journal of orthopaedic trauma · 2019
The Impact of Hemodialysis on Mortality and Personal Independence After Hip Fracture. A Prospective Matched Cohort Study.
СтатьяМногоцентровое исследованиеНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Orabona Nicola, Bove Antonio, Smeraglia Francesco, Rizzo Maria, Russo Bruno, Traficante Francesco, Mariconda Massimo
Аннотация
OBJECTIVE: To determine the cumulative 30-day and 1-year mortality as well as personal independence after hip fracture in patients on hemodialysis.
DESIGN: Prospective, observational cohort study with matched controls.
SETTING: One teaching hospital, one metropolitan trauma center, one peripheral hospital.
PATIENTS AND INTERVENTION: Study group: a consecutive cohort of 64 patients with end-stage renal disease receiving chronic hemodialysis who had undergone surgery for a trochanteric or femoral neck fracture from June 2008 to November 2016.
CONTROL GROUP: subjects without end-stage renal disease who underwent surgery for similar hip fractures.
MAIN OUTCOME MEASURE: One-year mortality, activities of daily living, and ambulatory activity.
RESULTS: The 30-day and 1-year mortality rate in patients with a hip fracture undergoing hemodialysis was 25.0% and 57.8%, respectively. Hemodialysis was independently associated with increased 30-day (Hazard ratio 2.933; 95% confidence interval 1.270-6.770; P = 0.018) and 1-year (hazard ratio 2.535; 95% confidence interval, 1.494-4.299; P < 0.001) mortality compared with the matched controls. At the 1-year follow-up, loss of personal independence in comparison with the prefracture status was detected.
CONCLUSIONS: Hemodialysis was associated with increased mortality after hip fracture. A worse prefracture functional status predicted the loss of functional independence at follow-up.
LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
DESIGN: Prospective, observational cohort study with matched controls.
SETTING: One teaching hospital, one metropolitan trauma center, one peripheral hospital.
PATIENTS AND INTERVENTION: Study group: a consecutive cohort of 64 patients with end-stage renal disease receiving chronic hemodialysis who had undergone surgery for a trochanteric or femoral neck fracture from June 2008 to November 2016.
CONTROL GROUP: subjects without end-stage renal disease who underwent surgery for similar hip fractures.
MAIN OUTCOME MEASURE: One-year mortality, activities of daily living, and ambulatory activity.
RESULTS: The 30-day and 1-year mortality rate in patients with a hip fracture undergoing hemodialysis was 25.0% and 57.8%, respectively. Hemodialysis was independently associated with increased 30-day (Hazard ratio 2.933; 95% confidence interval 1.270-6.770; P = 0.018) and 1-year (hazard ratio 2.535; 95% confidence interval, 1.494-4.299; P < 0.001) mortality compared with the matched controls. At the 1-year follow-up, loss of personal independence in comparison with the prefracture status was detected.
CONCLUSIONS: Hemodialysis was associated with increased mortality after hip fracture. A worse prefracture functional status predicted the loss of functional independence at follow-up.
LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Предметные рубрики MeSH
Activities of Daily LivingAgedCase-Control StudiesCause of DeathFemaleFemoral Neck FracturesFollow-Up StudiesFracture Fixation, IntramedullaryHospitals, TeachingHumansInjury Severity ScoreItalyKaplan-Meier EstimateKidney Failure, ChronicMaleMiddle AgedPostoperative ComplicationsProspective StudiesRecovery of FunctionReference ValuesRenal DialysisRisk AssessmentSurvival RateTreatment Outcome