老年髋部骨折患者死亡率与手术固定时机之间无关联：一项基于人群的回顾性队列研究结果

Lack of association between mortality and timing of surgical fixation in elderly patients with hip fracture: results of a retrospective population-based cohort study.

作者信息

Majumdar S R, Beaupre L A, Johnston D W C, Dick D A, Cinats J G, Jiang H X

机构信息

Division of General Internal Medicine, Department of Medicine, University of Alberta, and the Royal Alexandra Hospital, Edmonton, Alberta, Canada.

出版信息

Med Care. 2006 Jun;44(6):552-9. doi: 10.1097/01.mlr.0000215812.13720.2e.

DOI:10.1097/01.mlr.0000215812.13720.2e

PMID:16708004

Abstract

BACKGROUND

Conventional wisdom suggests high-quality care for most patients with hip fractures is surgical fixation within 24 hours to reduce mortality and complications, although there is little evidence to support this standard.

OBJECTIVES

We sought to determine the relationship between timing of hip fracture surgery and early mortality.

DESIGN AND SUBJECTS

This was a retrospective population-based cohort study of 3981 patients with hip fractures>60 years of age that were admitted to hospitals in one Canadian health region from 1994-2000.

METHODS

We collected sociodemographic, prefracture comorbidity, and postoperative complication data. Timing of surgery was classified as within 24 hours ("early surgery," the referent group for all analyses), 24-48 hours, and beyond 48 hours. Main outcome was in-hospital mortality. We used multivariable logistic regression methods, including adjustments with propensity scores and a validated hip fracture-specific mortality index, to determine the independent association between early versus later surgery and mortality.

RESULTS

Median age of patients was 82 years, 71% were women, and 26% had >4 prefracture comorbidities. Unadjusted in-hospital mortality was 6%; it was 5% for those who had surgery within 24 hours or from 24 to 48 hours, 10% for surgery beyond 48 hours, and 21% for patients that did not have surgery. Compared with those who had surgery within 24 hours, there was no independent association between timing of surgery and in-hospital mortality (24-48 hours, adjusted odds ratio 0.89, 95% confidence interval 0.62-1.30, P=0.55; beyond 48 hours 1.30, 95% confidence interval 0.86-2.00], P=0.21).

CONCLUSIONS

The timing of surgical fixation of hip fracture was not associated with early mortality in carefully adjusted analyses, and the use of "surgery within 24 hours" as a measure of high quality care may be inappropriate.

摘要

背景

传统观念认为，大多数髋部骨折患者接受高质量治疗的方式是在24小时内进行手术固定，以降低死亡率和并发症，尽管几乎没有证据支持这一标准。

目的

我们试图确定髋部骨折手术时机与早期死亡率之间的关系。

设计与研究对象

这是一项基于人群的回顾性队列研究，研究对象为1994年至2000年在加拿大一个卫生区域内住院的3981例年龄大于60岁的髋部骨折患者。

方法

我们收集了社会人口统计学、骨折前合并症和术后并发症数据。手术时机分为24小时内（“早期手术”，所有分析的参照组）、24至48小时以及48小时以上。主要结局是院内死亡率。我们使用多变量逻辑回归方法，包括倾向评分调整和经过验证的髋部骨折特异性死亡率指数，来确定早期手术与晚期手术和死亡率之间的独立关联。

结果

患者的中位年龄为82岁，71%为女性，26%在骨折前有超过4种合并症。未调整的院内死亡率为6%；24小时内或24至48小时内进行手术的患者死亡率为5%，48小时以上进行手术的患者死亡率为10%，未进行手术的患者死亡率为21%。与24小时内进行手术的患者相比，手术时机与院内死亡率之间没有独立关联（24至48小时，调整后的优势比为0.89，95%置信区间为0.62至1.30，P = 0.55；48小时以上为1.30，95%置信区间为0.86至2.00，P = 0.21）。