年長病人髖部骨折術後一年內死亡的風險因素

Risk Factors of One-Year Postoperative Mortality in Geriatric Patients with Hip Fracture

探討影響高齡髖部骨折病人術後1年內死亡之相關因子，以期建立臨床風險分級管理之參考實證。本研究採回溯性設計，分析2017年至2020年間北部某區域教學醫院接受髖部骨折手術之65歲以上病人，共計523位。收集個案之社會人口特徵、臨床變項與術前檢驗數據，並追蹤其術後1年內之存活情形。樣本平均年齡為81.5歲，女性佔69.8%，術後1年內死亡率為6.9%。多變項羅吉斯迴歸分析指出：骨折型態（勝算比= 2.5，p = 0.021）、術後72小時疼痛（勝算比= 2.7，p = 0.015）、術前肌酸酐較高（勝算比= 1.7，p = 0.001）、血小板降低（勝算比= 0.999，p = 0.030）及教育程度為不識字（勝算比= 3.7，p = 0.005）為顯著死亡預測因子。本研究結果突顯術前生理指標（如腎功能、凝血狀態）、臨床變項（骨折型態、術後疼痛）及社會人口特徵（教育程度）對高齡病人存活預後之關鍵影響。建議臨床實務應針對具備上述多重風險因子之高危群，及早啟動「骨折聯合照護服務」（FLS）等跨專業整合團隊，優化全手術期之風險評估與精準疼痛管理，以降低術後不良結果風險並提升長期預後。

To investigate the factors associated with one-year mortality in geriatric patients following hip fracture surgery, aiming to provide evidence-based insights for clinical risk stratification and management. This retrospective study analyzed 523 patients aged 65 years and older who underwent hip fracture surgery at a regional teaching hospital in northern Taiwan between 2017 and 2020. Data on sociodemographic characteristics, clinical variables, and preoperative laboratory results were collected. Survival status was tracked for one year postoperatively. The mean age of the sample was 81.5 years, with 69.8% being female. The one-year mortality rate was 6.9%. Multivariate logistic regression analysis identified the following as significant predictors of mortality: fracture type (Odds Ratio/ OR = 2.5, p = 0.021), postoperative 72-hour pain (OR = 2.7, p = 0.015), higher preoperative creatinine (OR = 1.7, p = .001), lower platelet count (OR = 0.999, p = 0.030), and illiteracy (OR = 3.7, p = 0.005). The findings highlight the critical impact of preoperative physiological indicators (e.g., renal function, coagulation status), clinical variables (fracture type, postoperative pain), and sociodemographic characteristics (education level) on survival prognosis. We recommend early initiation of multidisciplinary integrated teams, such as the Fracture Liaison Service (FLS), for high-risk patients with multiple risk factors. Optimizing perioperative risk assessment and precision pain management is essential to reduce adverse outcomes and enhance long-term prognosis.