β受體阻滯劑增加髖部手術后患者1年生存率:一項回顧性隊列研究
貴州醫(yī)科大學 麻醉與心臟電生理課題組
翻譯：胡廷菊 編輯：張中偉 審校：曹瑩
在過去15年里許多國家髖部手術后第一年病人死亡率一直居高不下。最近的研究表明，在髖部手術后的90天內β受體阻滯劑(BB)治療與風險調整死亡率的降低之間存在關聯(lián)。我們假設術前和術后持續(xù)BB治療也可能與髖部骨折術后一年內死亡率的降低有關。
在這項回顧性隊列研究中，納入了2008年1月1日至2017年12月31日期間在瑞典接受首次行急診髖關節(jié)骨折手術的所有成年患者。排除病理性骨折和保守治療的髖關節(jié)骨折患者，在手術前后一年內按處方服β受體阻滯劑的患者定義為正在進行BB治療。為了減少目前研究中由于非隨機化而導致的協(xié)變量混雜的影響，我們使用了逆概率加權法(IPTW)。隨后，在加權后的隊列中，使用Cox模型進行擬合。重復進行這些分析，排除術后30天內死亡的患者，這降低了由于手術和麻醉并發(fā)癥導致的早期死亡的影響，同時也降低了與普通人群相比，研究人群中出現(xiàn)的更高程度的提前預示，這使得獨立評估BB治療與死亡率之間的長期關聯(lián)成為可能。研究結果以危險比(HR)和95%可信區(qū)間(CI)表示。統(tǒng)計學意義定義為雙側P< 0.05。
本研究共納入病例134,915例。逆概率加權后，BB治療與術后第一年死亡率降低42%相關(調整后HR= 0.58, 95% CI, 0.57-0.60;P <0.001)。排除術后30天內死亡的患者后，BB治療與死亡率降低27%相關(調整HR = 0.73, 95% CI 0.71-0.75; P <0.001)。
正在接受BB治療的患者髖部骨折手術后的第一年死亡率顯著降低。對這一結論的進一步調查是有必要的。
Ahmad Mohammad Ismail，Rebecka Ahl，Maximilian Peter Forssten，et al.Beta-Blocker Therapy Is Associated With Increased 1-Year Survival After Hip Fracture Surgery: A Retrospective Cohort Study.[J]Anesth Analg2021 Nov 1;133(5):1225-1234.doi: 10.1213/ANE.0000000000005659.
Beta-Blocker Therapy Is Associated With Increased 1-Year Survival After Hip Fracture Surgery: A Retrospective Cohort Study
Abstract
Background: The high mortality rates seen within the first postoperative year after hip fracture surgery have remained relatively unchanged in many countries for the past 15 years. Recent investigations have shown an association between beta-blocker (BB) therapy and a reduction in risk-adjusted mortality within the first 90 days after hip fracture surgery. We hypothesized that preoperative, and continuous postoperative, BB therapy may also be associated with a decrease in mortality within the first year after hip fracture surgery.
Method:In this retrospective cohort study, all adults who underwent primary emergency hip fracture surgery in Sweden, between January 1, 2008 and December 31, 2017, were included. Patients with pathological fractures and conservatively managed hip fractures were excluded. Patients who filled a prescription within the year before and after surgery were defined as having ongoing BB therapy. The primary outcome of interest was postoperative mortality within the first year. To reduce the effects of confounding from covariates due to nonrandomization in the current study, the inverse probability of treatment weighting (IPTW) method was used. Subsequently, Cox proportional hazards models were fitted to the weighted cohorts. These analyses were repeated while excluding patients who died within the first 30 days postoperatively. This reduces the effect of early deaths due to surgical and anesthesiologic complications as well as the higher degree of advanced directives present in the study population compared to the general population, which allowed for the evaluation of the long-term association between BB therapy and mortality in isolation. Results are reported as hazard ratios (HR) with 95% confidence intervals (CI). Statistical significance was defined as a 2-sided P value<0.05.
Results:A total of 134,915 cases were included in the study. After IPTW, BB therapy was associated with a 42% reduction the risk of mortality within the first postoperative year (adjusted HR = 0.58, 95% CI, 0.57–0.60; P < .001). After excluding patients who died within the first 30 days postoperatively, BB therapy was associated with a 27% reduction in the risk of mortality (adjusted HR = 0.73, 95% CI, 0.71–0.75; P <0 .001).
Conclusion:A significant reduction in the risk of mortality in the first year following hip fracture surgery was observed in patients with ongoing BB therapy. Further investigations into this finding are warranted.
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