50歲以上髖關節骨折之歷年發生率、死亡率與手術併發症分析-以台灣人口為基礎之世代研究

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Title:	50歲以上髖關節骨折之歷年發生率、死亡率與手術併發症分析-以台灣人口為基礎之世代研究 Incidence, mortality and surgical complications of hip fracture in patients aged 50 or older – a population-based cohort study
Authors:	鄭奇浲;Cheng, Chi-Fung
Contributors:	公共衛生學系碩士班
Keywords:	健保資料庫;髖關節骨折;併發症;NHIRD;hip fracture;complication
Date:	2012-07-17
Issue Date:	2012-08-31 16:28:49 (UTC+8)
Publisher:	中國醫藥大學
Abstract:	背景：髖關節骨折是老年患者常見的損傷。據我們所知，一直沒有具體的人口研究，以評估台灣髖關節骨折患者術後的死亡或併發症的風險。本研究旨是藉由台灣的全國資料庫來評估大於50歲之髖關節骨折的發生率和術後死亡率以及內外科併發症。材料與方法：本研究的資料來自全民健康保險索賠記錄數據。挑選從1999年至2008年首次髖關節骨折並進行手術的患者追蹤至2010年。納入股骨頸骨折和股骨粗隆間骨折。並排除開放性骨折及病理性骨折，重大交通事故和嚴重創傷的患者。以進行發生率，死亡率，標準化死亡率(SMRs)和併發症的分析。結果：髖關節骨折的發生率在1999年為每十萬人264.7人至2008年為每十萬人262.2人。整體來說，在142,288人中，有78,819人死亡（55.4%）。1年內的死亡率在男性和女性中分別是19.3%和12.9%。長期的死亡率在男性和女性是60.2%和52.1%。髖關節骨折的患者比台灣的族群有更高的死亡風險(標準死亡率 = 2.7)。長期來看，在男性在內科、外科、全併發症的發生率為4.9%，15.9%，67.8%。女性在內科、外科、全併發症的發生率為3.7%，17.2%，61.7%。結論：此大規模且長期的研究指出，台灣在年齡大於50歲之髖關節骨折住院並手術之患者術後的死亡及內外科併發症。在研究期間，髖關節骨折的發生率呈現波動性的增減，女性的發生率每年皆比男性為高。50歲以上髖關節骨折之患者比一般族群有較高的死亡率，而在術後的存活情況來看，男性的存活情形較女性來的差。此族群患者若在術前共病症越多，其術後死亡的風險也越高。 Background: Hip fracture is a common injury of elder adults. To the best of our knowledge, there has been no specific population study to evaluate the risk of the postoperative death or complication for subjects with hip fracture in Taiwan. This study aims to calculate the incidence of hip fracture and to evaluate the postoperative mortality, medical and surgical complications among hip fracture in patients aged greater than 50 years from a nationwide database in Taiwan. Materials and Methods: This study analyzed the published national data from records of National Health Insurance claims. Subjects with surgery for hip fracture from 1999 to 2008 were selected and followed up to 2010. We included subjects with femoral neck fracture and trochanteric fracture. We also excluded subjects with open fracture, pathological fracture, major traffic accident and major trauma. Rates of incidence, mortality, standardized mortality ratios (SMRs) and complications were analyzed. Results: The incidence rates of hip fracture were 264.7 per 100,000 persons in 1999 to 262.2 per 100,000 persons in 2008. Overall, there were 78,819 deaths (55.4%) among 142,288 subjects. The 1-year mortality rates were 19.3% and 12.9% for male and female, respectively. The long-term mortality rates were 60.2% and 52.1% for male and female, respectively. Subject with hip fracture had a higher risk of death than the general population in Taiwan (standard mortality ratio, SMR = 2.7). The long-term incidence rates in male were 4.9%, 15.9%, 67.8% for medical, surgical, and overall complications, respectively. The long-term incidence rates in female were 3.7%, 17.2%, 61.7% for medical, surgical, and overall complications, respectively. Conclusion: This large-scale and long-term study reported the subsequent deaths, medical and surgical complications after surgery for hip fracture inpatients aged greater than 50 years in Taiwan. During the study period, the incidence of hip fractures showing the volatility of increase or decrease. The incidence of female was more than male each year. Hip fractures in patients who over the age of 50 had a higher mortality than the general population. Under the circumstance of postoperative survival, male survival situation was poor than female. This population in patients with preoperative who had more comorbidities, the higher risk of postoperative death will happen.
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