高齢者の大腿骨近位部骨折における周術期管理の統合モデルによる死亡率の低減

This pioneering study validates a novel ortho-internal treatment model providing integrated fracture and comorbidity management for high-risk elderly hip fracture patients. Results confirm significantly reduced mortality versus conventional approaches, demonstrating its unique capacity to optimize both surgical and non-surgical therapies while establishing surgery as the preferred option for eligible patients under this model.

Hip fractures in aged individuals with comorbidities pose complex treatment challenges and high mortality rates. While multiple multidisciplinary care models have been proposed globally, outcomes remain suboptimal for such cases. The present study assessed the efficacy of an ortho-internal treatment model, an integrated healthcare approach where physicians provide comprehensive care for patients with hip fractures and associated multiple comorbidities, to determine whether this novel model yields superior outcomes compared to existing multidisciplinary standards.

We retrospectively analyzed 1410 hip fracture patients treated at Tianjin Hospital's Ortho-internal Department (2015-2021), collecting demographic data, clinical information, and 1-year survival status. The main outcomes were mortality at 30, 60, 90, and 180 days and 1 year.

Of 1410 patients (mean age 80.61 ± 8.28 years, 68.16% with Charlson Comorbidity Index ≥ 5), 353 underwent surgery and 1057 received non-surgical treatment. Overall mortality rates at 30, 60, 90, and 180 days and 1 year were 7.01%, 10.07%, 12.41%, 17.09%, and 21.56%, respectively. Surgical group mortality rates at these time points (3.40%, 5.10%, 6.23%, 9.35%, 12.18%) were significantly lower than the non-surgical group (8.23%, 11.73%, 14.47%, 19.68%, 24.69%). The overall 5-year survival rate exceeded 50%, with the surgery group (66.6%) significantly higher than the non-surgery group (46.7%) and the entire cohort.

The ortho-internal model shows advantages in treating aged hip fracture patients with multiple comorbidities, outperforming published outcomes and offering a novel, effective approach to their care. Its capacity to optimize both surgical and conservative outcomes suggests this approach should be prioritized for complex cases. Notably, the model enables surgical access for previously ineligible patients, with surgery remaining beneficial despite higher perioperative risks.