【原】【罂粟摘要】β受体阻滞剂增加髋部手术后患者1年生存率:一项回顾性队列研究

β受体阻滞剂增加髋部手术后患者1年生存率:一项回顾性队列研究

贵州医科大学  麻醉与心脏电生理课题组

翻译：胡廷菊 编辑：张中伟  审校：曹莹

背景

       在过去15年里许多国家髋部手术后第一年病人死亡率一直居高不下。最近的研究表明，在髋部手术后的90天内β受体阻滞剂(BB)治疗与风险调整死亡率的降低之间存在关联。我们假设术前和术后持续BB治疗也可能与髋部骨折术后一年内死亡率的降低有关。

方法

        在这项回顾性队列研究中，纳入了2008年1月1日至2017年12月31日期间在瑞典接受首次行急诊髋关节骨折手术的所有成年患者。排除病理性骨折和保守治疗的髋关节骨折患者，在手术前后一年内按处方服β受体阻滞剂的患者定义为正在进行BB治疗。为了减少目前研究中由于非随机化而导致的协变量混杂的影响，我们使用了逆概率加权法(IPTW)。随后，在加权后的队列中，使用Cox模型进行拟合。重复进行这些分析，排除术后30天内死亡的患者，这降低了由于手术和麻醉并发症导致的早期死亡的影响，同时也降低了与普通人群相比，研究人群中出现的更高程度的提前预示，这使得独立评估BB治疗与死亡率之间的长期关联成为可能。研究结果以危险比(HR)和95%可信区间(CI)表示。统计学意义定义为双侧P< 0.05。

结果

       本研究共纳入病例134,915例。逆概率加权后，BB治疗与术后第一年死亡率降低42%相关(调整后HR= 0.58, 95% CI, 0.57-0.60;P <0.001)。排除术后30天内死亡的患者后，BB治疗与死亡率降低27%相关(调整HR = 0.73, 95% CI 0.71-0.75; P <0.001)。

结论

       正在接受BB治疗的患者髋部骨折手术后的第一年死亡率显著降低。对这一结论的进一步调查是有必要的。

原始文献来源

             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.

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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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