超高龄患者髋部骨折术后住院时间延长的危险因素

徐博文; 陈唯韫; 孙琛; 兰岭; 马璐璐; 裴丽坚

doi:10.24920/004465

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超高龄患者髋部骨折术后住院时间延长的危险因素

中国医学科学杂志（英文） 2025年40卷第2期页码：111-119

论著 | Updated：2025-09-02

- 超高龄患者髋部骨折术后住院时间延长的危险因素
- Affiliations：
  
  Department of Anesthesiology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing 100730, China
- Author bio：
  
  E-mail: hazelbeijing@vip.163.com
- Funds：
- DOI：10.24920/004465
  中图分类号：
- 收稿日期：2025-01-13，
  
  录用日期：2025-04-10，
  
  网络出版日期：2025-06-03，
  
  纸质出版日期：2025-06-30
- Accepted：
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徐博文,陈唯韫,孙琛等.超高龄患者髋部骨折术后住院时间延长的危险因素[J].中国医学科学杂志（英文）,2025,40(02):111-119.doi: 10.24920/004465

Xu Bo-Wen,Chen Wei-Yun,Sun Chen,et al.Risk Factors for Prolonged Postoperative Length of Stay After Hip Fracture Surgery in Very Elderly Patients[J].Chinese Medical Sciences Journal,2025,40(02):111-119.doi: 10.24920/004465
徐博文,陈唯韫,孙琛等.超高龄患者髋部骨折术后住院时间延长的危险因素[J].中国医学科学杂志（英文）,2025,40(02):111-119.doi: 10.24920/004465 DOI：

Xu Bo-Wen,Chen Wei-Yun,Sun Chen,et al.Risk Factors for Prolonged Postoperative Length of Stay After Hip Fracture Surgery in Very Elderly Patients[J].Chinese Medical Sciences Journal,2025,40(02):111-119.doi: 10.24920/004465 DOI：

摘要

背景

本研究旨在确定超高龄患者髋部骨折术后住院时间延长的危险因素，重点关注术后并发症以及不同麻醉方式对术后住院时间的影响。

方法

这项回顾性单中心队列研究纳入了2013年1月31日至2023年12月31日在北京协和医院接受髋部骨折手术的90岁及以上老年患者。收集相关围手术期数据。主要结局指标为术后住院时间，并根据术后住院时间将研究队列分为两组：术后住院时间≤7天组和＞7天组。采用逻辑回归分析确定与术后住院时间延长相关的危险因素。

结果

共纳入155例患者。平均年龄为（92.7±2.6）岁。73（47%）例患者的术后住院时间超过7天。术后住院时间＞7天与肺炎相关（

= 2.12，95%

［1.09， 4.16］，

= 0.028）。麻醉方式（相比于全身麻醉，区域麻醉

= 1.00，95%

［0.53， 1.90］，

= 0.993）、气道管理方式（相比于面罩/鼻导管给氧，喉罩通气

= 1.46，95%

［0.58，3.76］，

= 0.424，气管插管通气

= 0.82，95%

［0.39，1.69］，

= 0.592）与术后住院时间＞7天均无显著相关性。术前合并慢性阻塞性肺疾病（

= 2.78，95%

［1.05，7.65］，

= 0.040）和术前中性粒细胞计数（

= 1.13，95%

［1.01，1.26］，

= 0.029）与术后肺炎的发生相关，而麻醉方式和气道管理方式则与之无显著相关性。

结论

术后肺炎与超高龄髋部骨折患者术后住院时间延长相关，而麻醉方式、气道管理方式与术后住院时间延长或术后肺炎无显著相关性。术前合并症，尤其是呼吸系统疾病和全身性炎症，可能会对术后恢复构成重大影响。

Abstract

Objective

To identify risk factors contributing to prolonged postoperative length of stay (LOS) in very elderly patients following hip fracture surgery

with a focus on postoperative complications and the impact of different anesthesia approaches.

Methods

This retrospective single-center cohort study enrolled patients aged 90 years or older who underwent hip fracture surgery at Peking Union Medical College Hospital between January 31

2013 and December 31

2023. Relevant perioperative data were collected. The primary outcome was postoperative LOS

and the study cohort was divided into two groups: postoperative LOS ≤ 7 days and LOS > 7 days. Logistic regression was performed to identify factors related to prolonged postoperative LOS.

Results

A total of 155 patients were included. The average age was 92.7 ± 2.6 years. There were 73 (47%) patients with postoperative LOS

7 days. Postoperative pneumonia was the only factor associated with a prolonged postoperative LOS (

= 2.12

95%

[1.09

4.16

]

= 0.028). Neither the type of anesthesia (regional vs. general anesthesia

OR =

1.00

95%

[0.53

1.90

]

= 0.993) nor the method of airway management (laryngeal mask ventilation vs. spontaneous breathing

= 1.46

95%

[0.58

3.76

]

= 0.424; endotracheal intubation vs. spontaneous breathing

OR =

0.82

95%

[0.39

1.69

]

= 0.592) showed a significant association with a prolonged postoperative LOS. Preoperative chronic obstructive pulmonary disease (

= 2.78

95%

[1.05

7.65

]

= 0.040) and preoperative neutrophil count (

= 1.13

95%

[1.01

1.26

]

= 0.029) were both significantly associated with the occurrence of postoperative pneumonia

while anesthesia type and airway management method were not.

Conclusions

Postoperative pneumonia was associated with prolonged postoperative LOS in very elderly patients undergoing hip fracture surgery

whereas anesthesia types and airway management methods show no association with prolonged postoperative LOS or postoperative pneumonia. Preoperative comorbidities

especially respiratory conditions and systemic inflammation

potentially play a substantial role in postoperative recovery.

关键词

Keywords

references

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