Analysis of risk factors for 90-day mortality after surgery in elderly patients with intertrochanteric fractures and a history of cardiovascular disease.

Abstract

This study explored the risk factors for all-cause mortality 90 days after surgery in elderly patients with intertrochanteric fractures and a history of cardiovascular disease. We retrospectively analyzed the clinical data of 166 elderly patients with intertrochanteric fractures who were admitted to the Department of Orthopedics of Sichuan Provincial People's Hospital (Eastern Hospital) between January 1, 2010 and December 31, 2014. Kaplan-Meier survival curve analysis and the logrank test were used to compare all-cause mortality in the 90-day postoperative period for elderly patients with intertrochanteric fractures and a history of cardiovascular disease. In addition, we used the Cox proportional hazards model to explore related risk factors and their relative hazard rate (HR). A multivariate Cox regression model was established for elderly patients with intertrochanteric fractures and a history of cardiovascular disease and all-cause mortality within 90 days after surgery. The risk factors suggested by the model were length of hospital stay (HR =1.07, Z=4.26, P<0.001), N-terminal pro brain natriuretic peptide (NT-proBNP) (HR =1.01, Z=4.61, P<0.001), and high-density lipoprotein (HDL) (HR =0.41, Z=2.05, P=0.042). The area under the working curve (AUC) of the Cox regression model was 0.91. The Kaplan-Meier survival curves grouped by length of stay, NT-proBNP, and HDL risk factors were significantly different (P<0.05). As the length of hospital stay increased, abnormally elevated NT-proBNP significantly increased all-cause mortality within 90 days after surgery, while elevated HDL significantly reduced patient mortality. The results of our study suggested that the combination of these 3 indicators could be used as a sensitive predictor for prognosis in elderly patients with intertrochanteric fracture surgery and a history of cardiovascular disease.