Perioperative biochemical markers and early postoperative mortality in senile patients with femoral intertrochanteric fracture / 中华创伤骨科杂志

ABSTRACT

Objective To investigate the associations between levels of perioperative biochemical markers of the liver,kidney,lung and heart and death within 3 months postoperatively in the senile patients with femoral intertrochanteric fracture.Methods A retrospective study was conducted on the 153 senile patients with femoral intertrochanteric fracture who had been treated at Nanfang Hospital from January 2010 to January 2012.They were 71 men and 82 women,with an average age of 83.1 years.There were 70 stable and 83 unstable fractures.At preoperation (within 24 h after admission),and 24 h,25 to 48 h and 72 h postoperation,all the patients had blood examinations of biochemical markers of the liver [alanine aminotransaminase (ALT)],kidney (creatinine and urea nitrogen),lung (PaO2) and heart [brain natriuretic peptide (BNP)].The levels of biochemical markers at all time points and clinical data were compared between the living patients and those who died within 3 months postoperatively.Univariate and multivariate logistic regression analyses were conducted to estimate the independent risk factors for mortality within 3 months postoperatively.Results Of the 153 patients,32 (20.9％) died within 3 months postoperatively,including 10 men and 22 women.In the dead and surviving patients,there were respectively 25 and 17 cases who were rated as level Ⅲ or Ⅳ by ASA (American Society of Anesthesiologists).The levels of ALT,creatinine,urea nitrogen,and BNP increased to different extents while the level of PaO2 decreased postoperatively in both the dead and surviving patients.The differences between the dead and surviving patients were statistically significant (P ＜ 0.05).Multivariate logistic regression analysis showed poor preoperative physical condition (ASA level Ⅲ or Ⅳ),increased creatinine level at 25 to 48 h postoperation,decreased PaO2 at 72 h postoperation,and increased BNP level at 24 h postoperation were independent risk factors for early mortality in senile patients with femoral intertrochanteric fracture.Conclusions Femoral intertrochanteric fracture in senile patients may lead to changes in the liver,kidney,lung and heart.Prompt and dynamic monitoring of the levels of PaO2,creatinine and BNP may provide timely prediction of the poor prognosis.