Analysis of the causes of complications and death of the femoral intertrochanteric fracture during perioperative peri-od / 中华骨科杂志

ABSTRACT

Objective To analyze the causes of complications and death of the femoral intertrochanteric fracture during perioperative period, and to assess the orthopedics surgery risk of aged. Methods 499 of 547 cases were retrospectively re?viewed (132 male, 367 female), who underwent operation from May 2007 to Jun 2014 in our hospital. Their age varied from 59 to 103 years old, with an average of 78.3 ± 7.3 years old. According to Evans classification, there were 84 cases of type I, 67 type II, 187 type III, and 161 type IV. The causes of death were analyzed and discussed. The factors including health assess?ment before operation, age, operating time and blood loss were studied statistically to find out their correlation with mortality of operation. Results There were altogether 354 complications, including pulmonary infection, urinary system infection, DVT, and cardiac events. There were 30 cases of death and the mortality was 6.0%. The major causes of death included infectious shock, pulmonary infection, cardiac events, kidney failure and hemorrhagic shock caused by hepatic rupture. Statistical results from the score of APACHEⅡshowed the factor which definitely influenced the mortality was the amount of blood loss during op?eration.APACHEⅡscoring area under the ROC curve was 0.938, and the best cutoff value was 17.5 (about an index of 0.767), with the sensitivity of 86.7%and specificity of 90%. The area of risk of death under the ROC curve by APACHE Ⅱscore was 0.817, the best cutoff value of 16.765%(about an index of 0.483), and the sensitivity and specificity of 93.3%and 55.0%. Conclu?sion There were a lot of complications and accompanied diseases when femoral intertrochanteric fractures happened in aged pa?tients. The main cause of death was septic shock. There were relationships between hemoglobin and the operating time and the de?gree of trauma. What’s more, it was confirmed that the APACHEⅡscoring system was very useful to value the condition of the patients with femoral intertrochanteric fractures, which can be recommended.