【摘要】 目的 探讨接受全髋关节置换术(total hip replacement, THA)患者的一般情况、合并症和围手术期因素，了解这些因素与术后住院时间(length of stay, LOS)的相关性。方法 回顾性分析2015年1月至2019年12月于苏州大学附属第二医院接受THA的绝经后股骨颈骨折患者病历资料。共纳入患者637例，平均年龄(70.6±6.5)岁，平均体质量指数(body mass index, BMI)为(28.2±5.7)kg/m~2,术后LOS中位数为7(6,8)d,术后LOS长于中位数的有263例(占41.3%)。采用Logistic回归方法分析影响LOS的相关因素。结果 (1)运用单因素分析方法分析了影响THA的LOS因素，其中年龄、BMI、入院时间、ASA(美国麻醉医师协会)分级、合并症、术前等待时间、手术时间、贫血、术后低蛋白血症、术后不良事件这十项指标有统计学意义(P<0.05);(2)将P<0.1的因素纳入二元Logistic回归模型进行多因素分析，其中年龄>70岁(OR:1.513;95%CI:1.032～2.260;P<0.001)、BMI<18.5 kg/m~2(OR:1.577;95%CI:1.073～2.319;P=0.021)、周五或周六入院(OR:1.558;95%CI:1.154～2.412;P=0.007)、ASA Ⅲ/Ⅳ级(OR:2.076;95%CI:1.472～2.926;P<0.001)、合并术前贫血(OR:1.665;95%CI:1.338～2.072;P<0.001)、合并术后不良事件(OR:1.814;95%CI:1.174～2.803;P=0.007)这六项指标为LOS延长的独立危险因素。结论 术后住院时间(LOS)与老年人术后恢复状况关系密切，绝经后股骨颈骨折患者THA术后LOS延长与部分人口学、合并症、围手术期指标、入院时间等因素相关；其中有六项指标是独立危险因素。更多还原

【Abstract】 Objective With the arrival of an aging society, the incidence of postmenopausal femoral neck fractures is increasing. This study focused on retrospective analysis of the general conditions, comorbidities and perioperative factors of these patients undergoing total hip arthroplasty(THA). Understanding the correlation between these factors and postoperative hospital stay(LOS) can provide some reference for future treatment plan structured intervention and process improvement. Methods The medical records of postmenopausal patients with femoral neck fractures who received THA in the Second Affiliated Hospital of Soochow Universityfrom January 2015 to December 2019 were retrospectively analyzed. A total of 637 patients were included, with an average age of 70.6±6.5 years, an average BMI of 28.2±5.7 kg/m~2, a median LOS of 7(6,8) days, and 263 patients(41.3%) with a LOS longer than the median; Logistic regression method was used to analyze the related factors affecting LOS. Results(1)Univariate analysis was used to analyze the LOS factors affecting THA, including age, BMI, admission time, ASA(American Society of Anesthesiologists) classification, comorbidities, preoperative waiting time, operation time, anemia, postoperative hypoalbuminemia. The 10 indexes of symptoms and postoperative adverse events were statistically significant(P<0.05).(2)The factors of P<0.1 were included in the binary logistic regression model for multivariate analysis, in which age >70 years old(OR: 1.513; 95% CI: 1.032-2.260; P<0.001), BMI<18.5 kg/m~2(OR: 1.577; 95% CI: 1.073-2.319; P=0.021), admission on Friday or Saturday(OR: 1.558; 95% CI:1.154-2.412; P=0.007), ASA Ⅲ/Ⅳ(OR: 2.076; 95% CI: 1.472-2.926; P<0.001), combined with preoperative anemia(OR: 1.665; 95% CI: 1.338-2.072;P<0.001), combined with postoperative adverse events(OR: 1.814; 95% CI: 1.174-2.803; P=0.007) Six indicators were independent risk factors for prolonged LOS. Conclusion The length of postoperative hospital stay(LOS) is closely related to the postoperative recovery status of the elderly. The prolonged LOS after THA in postmenopausal femoral neck fracture patients is related to some demographics, comorbidities, perioperative indicators, admission time and other factors. Six indicators are independent risk factors; therefore, understanding these independent risk factors, improving the level of individualized intervention as much as possible, and improving the perioperative process in a differentiated manner will be very beneficial to shorten the LOS after THA in patients with postmenopausal femoral neck fractures.更多还原