Key result
Poor fracture reduction quality linked to ~567% higher all-cause mortality risk versus excellent reduction.
Why the study?
The study aimed to investigate the relationship between the Chang reduction quality criteria (CRQC) and the outcome of elderly intertrochanteric fractures across follow-up periods.
Does poor or acceptable fracture reduction quality according to CRQC increase all-cause mortality in elderly patients with intertrochanteric fractures compared to excellent reduction?
Cohort (n=389)
No
Does poor or acceptable fracture reduction quality according to CRQC increase all-cause mortality in elderly patients with intertrochanteric fractures compared to excellent reduction?
Hazard Ratio: 6.67 (95% CI 3.48–12.77)
Absolute Event Rate: 53.85% vs 16.67%
p-value: p=<0.001
In elderly patients with intertrochanteric fractures, acceptable or poor reduction quality according to the Chang reduction quality criteria is associated with significantly increased all-cause mortality compared to excellent reduction.
Emphasizes need for excellent reduction in intertrochanteric fractures; leaves open whether optimizing quality improves survival in trials.
Objective The aim of this study was to investigate the relationship between the Chang reduction quality criteria (CRQC) and the outcome of elderly intertrochanteric fractures based on a subgroup of follow-up time. Methods Retrospective analysis of 389 elderly patients with intertrochanteric fractures treated surgically from January 2019 to June 2021, including 130 males and 259 females; age 84.64 (77.50-89.74) years. Patient survival was followed by telephone between admission to hospital for fracture and death, or until study deadline (June 1, 2022). According to the CRQC, were divided into Poor, Acceptable, Excellent three groups. Based on total follow-up time and 1-year follow-up, univariate and multivariate Cox proportional hazard models were used to assess the association between CRQC and all-cause mortality in elderly intertrochanteric fractures. Further subgroup analysis was performed according to different clinical and biological characteristics to make the results more accurate. Results The mortality were 24.68% and 15.42% at 1 year and total follow-up, respectively. In the total follow-up time and 1-year follow-up time, the mortality of CRQC-Excellent was significantly lower than that of CRQC-Acceptable (p.adj < 0.05), and was significantly lower than that of CRQC-Poor (p.adj < 0.05). After multi-factor adjustment, CRQC-Acceptable and Poor in were independent risk factors affecting the overall mortality and 1-year mortality. In addition, advanced age, comorbidities ≥ 1, ASA3 + 4, and prolonged preoperative waiting time were independent risk factors for survival in the total follow-up time. At 1-year follow-up, only ASA3 + 4 and prolonged preoperative waiting time were independent risk factors for survival. Subgroup analysis according to different characteristics at the total follow-up time and at the one-year follow-up time showed that in most subgroups as CRQC decreased was significantly associated with an increase in all-cause mortality (p for trend < 0.05). Conclusions This study highlights that CRQC-Acceptable and Poor are associated with increased all-cause mortality in elderly intertrochanteric fractures. We should try to achieve good reduction of these fractures.
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He et al. (2022) conducted a cohort in Elderly intertrochanteric fractures (n=389). Poor fracture reduction quality (Chang reduction quality criteria) vs. Excellent fracture reduction quality was evaluated on All-cause mortality at total follow-up (HR 6.67, 95% CI 3.48-12.77, p=<0.001). Poor fracture reduction quality according to the Chang reduction quality criteria was independently associated with a significantly higher risk of all-cause mortality (HR 6.67) compared to excellent reduction.
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