Quantitative analysis of operation risks for femoral intertrochanteric fractures under the guidance of Acute Physiology and Chronic Health Evaluation system

Abstract

Objective To quantitatively analyze the operation risks for femoral intertrochanteric fractures under the guidance of Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ). Methods A retrospective analysis was performed among the 226 patients with femoral intertrochanteric fracture who had received surgery between January 2013 and January 2016. They were 59 men and 167 women, aged from 69 to 106 years (average, 75.4±6.1 years). Their average APACHEⅡ score was 18.3±6.3 (from 5 to 34). They were divided into 3 groups according to their APACHEⅡ scores: 127 cases in the low risk group (≤ 15), 68 cases in the medium risk group (from 16 to 24) and 31 cases in the high risk group (≥25). The mortality was compared between the 3 groups. The deaths and survivals were compared in each group in terms of age, operation time, intraoperative blood loss, postoperative blood transfusion and combined internal diseases. Results Thirteen patients died during hospitalization, giving a mortality of 5.7% (13/226). The causes for death were heart attack in 6 cases, respiratory failure in 4, toxic shock in 2 and renal failure in one. The mortality in the high risk group (22.6%, 7/31) was significantly higher than in the low risk group (1.6%, 2/125) and in the medium risk group (5.9%, 4/68) (P<0.05). In the low risk group, the intraoperative blood loss was statistically different between deaths and survivals (P<0.05); in the medium risk group, the intraoperative blood loss and postoperative blood transfusion volume were statistically different between deaths and survivals (P< 0.05); in the high risk group, the age and intraoperative blood loss were statistically different between deaths and survivals (P<0.05). Conclusions APACHEⅡ can be used to quantitatively evaluate the patients with femoral intertrochanteric fracture who usually suffer from intraoperative complications and concomitant internal diseases. The most significant risk factor may be intraoperative blood loss. Key words: Hip fractures; Scoring system; Mortality