Effect Of Chronic Left Heart Failure On Postoperative Long-term Mortality Of Hip Fracture In The Elderly

Objective: To explore the relationship between mortality and heart failure by collecting regular follow-up data of elderly patients with hip fracture during hospitalization and after discharge.Methods: In this observational cohort study,768 patients with unilateral hip fracture(unilateral femoral neck or unilateral intertrochanteric fracture)who were admitted to Fengfeng Group General Hospital from January 2015 to January 2018 and received surgical treatment were enrolled.According to LVEF,symptoms,and NT-pro-BNP,the patients were divided into non-heart failure group(695 cases)and heart failure group(73 cases)before surgery.Record the following information: age,gender,left ventricular ejection fraction(suspected heart failure patients with NT-pro-BNP check),hemoglobin,peptic ulcer,chronic obstructive pulmonary disease,coronary heart disease,hypertension,diabetes,fracture type(femoral neck or intertrochanteric fractures),preoperative American society of anesthesiologists score,place of residence,time from injury to operation.Differences in cumulative crude death rates at 12,24,36 and 48 months were measured and compared between the two groups.The effects of these factors on the relationship between heart failure and postoperative mortality in patients with hip fractures were evaluated.Postoperative mortality in patients with hip fractures was compared among different heart failure subtypes.Results: The mortality rates at 12,24,36,and 48 months after hip fracture were7.79%,22.08%,27.27%,29.87%,respectively.Univariate analysis showed that heart failure,gender,age over 80 years,anemia,chronic obstructive pulmonary disease,coronary heart disease,diabetes,hypertension,ASA score ≥III,place of residence,time from injury to operation greater than 2 days could affect postoperative survival time of patients with hip fracture,and the difference was statistically significant.Multivariate COX proportional hazard model was constructed and show that male,age >,80 years,anemia,COPD,CHD,diabetes,ASA score ≥III,and rural residence were independent factors influencing postoperative survival time of patients with hip fracture.And the above factors did not affect the relationship between heart failure and postoperative mortality of patients with hip fracture.There was no statistically significant difference in postoperative mortality of hip fracture among patients with different subtypes of heart failure.Conclusion: After adjusting for gender,age,COPD,CHD,diabetes,hypertension,ASA score,place of residence,time from injury to surgery,chronic heart failure is still an independent factor of higher postoperative mortality in elderly patients with hip fracture.Active improvement of cardiac function and regulation of heart failure-related diseases during perioperative period can help improve postoperative quality of life and prognosis of hip fracture.