Predictors and Prognosis in Perioperative Complications and Survival among Elderly Hip Fracture Patients with Paroxysmal or Permanent Atrial Fibrillation: a nested case–control study

Abstract

Abstract Background A dearth of data exists concerning atrial fibrillation (AF) during the perioperative stage of non-cardiothoracic surgery, particularly orthopaedic surgery. Therefore, given the frequency and significant impact of AF in the perioperative period. We need to make sure the prognosis of paroxysmal and permanent AF and the predictors of perioperative paroxysmal AF. Methods An examination of hip fracture patients at the Third Hospital of Hebei Medical University, who had been hospitalized from January 2018 to October 2020 in succession, was conducted retrospectively. To determine independent risk factors for paroxysmal AF in elderly hip fracture patients, univariate and multivariate logistic regression analysis were employed. The Kaplan-Meier survival curve demonstrated the correlation between all-cause mortality in the non-AF, paroxysmal AF, and permanent AF groups. An assessment of the correlation between baseline factors, complications, and all-cause mortality was conducted through univariable and multivariable Cox proportional hazards analysis. Results Enrolling 1,376 elderly patients with hip fractures, we found 1,189 in the non-AF group, 103 in the paroxysmal AF group, and 84 in the permanent AF group. Of the 1376 patients, the majority were female (70.3%) with an average age of 79.51 years, and the majority of them were over 75 years of age (72.5%) - the majority. Kaplan-Meier plots revealed a significantly lower overall survival rate in elderly individuals suffering from hip fracture, as well as especially permanent AF. Based on our COX regression analysis, we found that the main risk factors for all-cause death in elderly patients with hip fracture combined with AF patients were concomitant pulmonary infection, hyponatremia, permanent AF and age. Elderly patients with hip fracture combined with paroxysmal AF group showed a higher incidence of perioperative complications, such as hypertension, COPD and ACCI were independent risk factors for paroxysmal AF in elderly patients with hip fracture. Conclusions The prevention of paroxysmal AF in elderly patients with hip fractures is of paramount importance. And avert complications and potential mortality also significant, elderly patients with hip fracture, particularly those with permanent AF, must be given suitable perioperative care to avert the risks of pulmonary infection and hyponatremia.