Gdalevich Michael, Cohen Dani, Yosef Dina, Tauber Chanan
Ashkelon District Health Office, Barzilai Medical Center, Ashkelon, Israel.
Arch Orthop Trauma Surg. 2004 Jun;124(5):334-40. doi: 10.1007/s00402-004-0662-9. Epub 2004 Apr 17.
The relationship between the timing of surgery after hip fracture and the subsequent survival of the patient has been studied extensively, yet still remains a controversy. This study aims to assess the impact of operative delay on the 1-year survival of patients and on the rate of complications during the postoperative hospital stay.
Medical and demographic data were extracted from the hospital records of 651 consecutive hip fracture patients over 60 years old. Information on mortality was obtained by cross-linkage with the Department of Interior population files. The multivariate survival analysis model was utilized to assess the association between the time from fracture incident to surgery and the outcome (1-year survival and postoperative complications).
The hazard ratio (HR) of 1-year mortality for postponing surgery beyond 48 h was 1.63 (95%CI 1.11-2.40), as derived by the Cox proportional hazards model. Other variables found to be independently associated with decreased survival are: male gender (HR=1.54), mental deterioration (HR=2.94), postoperative mobility (HR=2.45), and severity of pre-existing diseases (HR=1.96). Occurrence of general complications during the postoperative hospital stay was a significant predictor of decreased 1-year survival (HR=1.83).
These findings suggest that early (within 48 h) surgical treatment of hip fractures is associated with improved 1-year survival.
髋部骨折后手术时机与患者后续生存之间的关系已得到广泛研究，但仍存在争议。本研究旨在评估手术延迟对患者1年生存率及术后住院期间并发症发生率的影响。
从651例60岁以上连续髋部骨折患者的医院记录中提取医疗和人口统计学数据。通过与内政部人口档案交叉链接获取死亡率信息。采用多变量生存分析模型评估从骨折事件到手术的时间与结局（1年生存率和术后并发症）之间的关联。
根据Cox比例风险模型得出，手术推迟超过48小时的1年死亡率风险比（HR）为1.63（95%CI 1.11 - 2.40）。发现与生存率降低独立相关的其他变量包括：男性（HR = 1.54）、精神衰退（HR = 2.94）、术后活动能力（HR = 2.45）以及既往疾病严重程度（HR = 1.96）。术后住院期间发生全身并发症是1年生存率降低的显著预测因素（HR = 1.83）。
这些发现表明，髋部骨折的早期（48小时内）手术治疗与1年生存率提高相关。
