Yaşlılarda İnstabil İntertrokanterik Kırıklarda Cerrahi Sonrası Bir Yıllık Mortaliteyi Belirleyen Çok Değişkenli Etkenler

Öz

Amaç: Yaşlı erişkinlerde instabil intertrokanterik femur kırıkları sonrası bir yıllık mortalite halen yüksektir; komorbidite yükü, perioperatif faktörler ve inflamatuvar belirteçleri birlikte değerlendiren bütüncül prognostik modeller ise sınırlıdır. Materyal ve metod: Bu retrospektif tek merkezli kohort çalışmasında, AO/OTA 31A2–31A3 kırığı olan ve 2017–2020 yılları arasında antirotator proksimal femoral çivi (A-PFN) veya çimentosuz bipolar hemiartroplasti (HA) uygulanan ≥65 yaşındaki 141 hasta değerlendirildi. Birincil sonlanım noktası ameliyat sonrası bir yıllık mortaliteydi. Başlangıç demografik veriler, Charlson Komorbidite İndeksi (CCI), ameliyata kadar geçen süre, hastanede kalış süresi, transfüzyon ünite sayısı ve başvuru anındaki inflamatuvar belirteçler (NLR, PLR, MLR, SII) analiz edildi. Tek değişkenli ilişkiler Spearman korelasyonu ve ki-kare/Fisher testleri ile değerlendirildi; ardından kolinerlik tanıları ve adım adım azaltma (step-down) yaklaşımı ile çok değişkenli lojistik regresyon uygulandı.
Bulgular: Bir yıllık mortalite %35,5 (50/141) olarak saptandı. Tek değişkenli analizlerde mortalite; ameliyata kadar geçen süre, hastanede kalış süresi, CCI, NLR, PLR, MLR ve SII ile ilişkiliydi (tümü p<0,05). Tam çok değişkenli modelde yalnızca CCI (OR 2,807, %95 GA 1,619–4,860; p<0,001), MLR (OR 2,034, %95 GA 1,133–3,647; p=0,017) ve SII (OR 3,007, %95 GA 1,010–8,953; p=0,048) bağımsız belirleyiciler olarak kaldı. Model indirgeme sonrası da bu ilişkiler korundu: CCI (OR 2,71, %95 GA 1,63–4,50; p<0,001), MLR (OR 1,69, %95 GA 1,05–2,72; p=0,030) ve SII (OR 1,73, %95 GA 1,03–2,91; p=0,037). Cerrahi teknik (A-PFN’ye karşı HA) mortalite ile bağımsız olarak ilişkili değildi.
Sonuç: Yaşlı instabil intertrokanterik kırık hastalarında komorbidite yükü (CCI) ve inflamatuvar durum (MLR, SII) bir yıllık mortaliteyi bağımsız olarak öngörürken, cerrahi yöntem bağımsız bir belirleyici değildir. Ameliyat öncesi klinik-inflamatuvar birleşik değerlendirme risk sınıflamasını geliştirebilir; bulguların dış doğrulama ile desteklenmesi gereklidir.

Anahtar Kelimeler

• İntertrokanterik Femur Kırığı
• Bir Yıllık Mortalite
• Charlson Komorbidite İndeksi
• Monosit/Lenfosit Oranı
• Sistemik İmmün-İnflamasyon İndeks
• Geriatrik Kalça Kırığı

Destekleyen Kurum

Herhangi bir fon, hibe veya başka bir destek alınmamıştır.

Etik Beyan

Ethical approval was obtained from the Clinical Research Ethics Committee of Sağlık Bilimleri University Kanuni Sultan Süleyman Training and Research Hospital (approval no: 112, date: August 9, 2023).

Teşekkür

: The authors thank all individuals who contributed to the study but did not meet the authorship criteria.

Multivariate Determinants of One-Year Mortality Post-Surgery for Unstable Intertrochanteric Fractures in the Elderly

Öz

Background: One-year mortality after unstable intertrochanteric femur fractures in older adults remains high, and integrated prognostic models that combine comorbidity burden, perioperative factors, and inflammatory indices are limited.
Materials and Methods: In this retrospective single-center cohort, 141 patients aged ≥65 years with AO/OTA 31A2–31A3 fractures (2017–2020) underwent antirotator proximal femoral nailing (A-PFN) or cementless bipolar hemiarthroplasty (HA). The primary endpoint was one-year postoperative mortality. Baseline demographics, Charlson Comorbidity Index (CCI), time to surgery, length of stay, transfusion units, and admission inflammatory markers (NLR, PLR, MLR, SII) were analyzed. Univariable associations were assessed using Spearman correlation and chi-square/Fisher tests, followed by multivariable logistic regression with collinearity diagnostics and step-down model reduction. Results: One-year mortality was 35.5% (50/141). In univariable analyses, mortality was associated with time to surgery, hospital stay, CCI, NLR, PLR, MLR, and SII (all p<0.05). In the full multivariable model, only CCI (OR 2.807, 95% CI 1.619–4.860; p<0.001), MLR (OR 2.034, 95% CI 1.133–3.647; p=0.017), and SII (OR 3.007, 95% CI 1.010–8.953; p=0.048) remained independent predictors. After model reduction, these associations persisted: CCI (OR 2.71, 95% CI 1.63–4.50; p<0.001), MLR (OR 1.69, 95% CI 1.05–2.72; p=0.030), and SII (OR 1.73, 95% CI 1.03–2.91; p=0.037). Surgical technique (A-PFN vs HA) was not independently associated with mortality.
Conclusions: In elderly patients with unstable intertrochanteric fractures, comorbidity burden (CCI) and inflammatory status (MLR, SII) independently predicted one-year mortality, whereas surgical method did not. Combined preoperative clinical-inflammatory assessment may improve risk stratification; external validation is warranted.

Anahtar Kelimeler

• Intertrochanteric Femur Fracture
• One-Year Mortality
• Charlson Comorbidity Index
• Monocyte-To-Lymphocyte Ratio
• Systemic Immune-Inflammation Index
• Geriatric Hip Fracture

Destekleyen Kurum

No funds, grants, or other support was received.

Etik Beyan

Ethical approval was obtained from the Clinical Research Ethics Committee of Sağlık Bilimleri University Kanuni Sultan Süleyman Training and Research Hospital (approval no: 112, date: August 9, 2023).

Teşekkür

The authors thank all individuals who contributed to the study but did not meet the authorship criteria.

Kaynakça

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