Preoperative Thyroid Dysfunction Predicts 30-Day Postoperative Complications in Elderly Patients With Hip Fracture

Autor: Xi Wern Ling MBBS, Tet Sen Howe MBBS, FRCS, FAMS, Joyce Suang Bee Koh MBBS, FRCS, FAMS, Merng Koon Wong MBBS, FRCS, FAMS, Alvin Choong Meng Ng MBBS, MMed, MRCP
Jazyk: angličtina
Rok vydání: 2013
Předmět:
Zdroj: Geriatric Orthopaedic Surgery & Rehabilitation, Vol 4 (2013)
Druh dokumentu: article
ISSN: 2151-4585
2151-4593
21514585
DOI: 10.1177/2151458513504215
Popis: Objectives: To investigate the relationship between thyroid function and short-term outcomes in elderly patients undergoing surgery for hip fracture. Methods: Patients aged >60 years admitted from July 2009 to June 2010 who underwent surgical fixation of low-energy hip fracture, excluding those with pathological or periprosthetic fracture, were enrolled in a retrospective observational cohort study. Patients were classified as having biochemically overt or subclinical hyperthyroidism or hypothyroidism, normal thyroid function, or nonclassifiable state based on preoperative thyroid-stimulating hormone and free thyroxine values. Outcome data were collected from hospital records. Biochemical thyroid dysfunction was not systematically treated. Outcomes measured were length of stay (LOS), 30-day postoperative complications, readmissions, and mortality. Results: A total of 254 patients were analyzed; 64 (25.2%) were male and mean age was 77.8 years. There were 128 (50.4%) patients with euthyroid, 68 (26.8%) nonclassifiable, 13 (5.1%) overtly hyperthyroid, 20 (7.9%) subclinically hyperthyroid, 4 (1.6%) overtly hypothyroid, and 21 (8.3%) subclinically hypothyroid. The 30-day postoperative complication rate was 38% (96 patients). The most common complication was urinary tract infection (12.6%), followed by cardiac events (8.3%) and delirium (5.5%). Patients with overt hyperthyroidism had an increased risk of complications in multivariate analysis (odds ratio 3.75, 95% confidence interval 1.10-12.84). Complications in this group were similar to those in the overall cohort. Thyroid function did not predict LOS, readmissions, or mortality. Conclusion: Older patients frequently develop complications following surgery for hip fractures. This risk appears to be increased by preoperative biochemically overt hyperthyroidism. Further study is warranted to confirm this finding and to determine whether preoperative treatment improves outcomes.
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