Pillay J, van der Wouden J C, Leenen L P H
Universitair Medisch Centrum Utrecht, afd. Chirurgie, Heidelberglaan 100, 3584 CX Utrecht.
Ned Tijdschr Geneeskd. 2007 Apr 28;151(17):967-70.
To evaluate whether patients with hip fracture who undergo surgery within 24 hours--which has been propagated as an indicator of quality care--is associated with a reduced risk of mortality and complications, compared with later surgery.
Retrospective status study based on a prospectively designed electronic medical record.
Data were collected on patients aged > or =60 years who were admitted to the University Medical Centre Utrecht, the Netherlands, between 1 January 2000 and 31 December 2003 for hip fracture. Outcomes were compared in patients who underwent surgery within 24 hours and those who underwent surgery after more than 24 hours. The primary outcome measure was mortality (in-hospital, after 3 months, 12 year and 3 years after discharge). Secondary outcome measures were postoperative complications, postoperative duration ofhospital stay and admission to long-term care facilities. We corrected for age, gender and pre-existing comorbidity.
A total of 217 patients were included. In the 150 patients who underwent surgery within 24 hours, the mean age was 80.5 years, 75% were female and 28% were class III or IV according to the American Society of Anesthesiologists (ASA). In the 67 patients who underwent surgery after more than 24 hours, the mean age was 80.9 years, 82% were female, and 49% were ASA class III or IV. After correcting for published risk factors, there was no relationship between the timing of surgery and mortality. Fewer patients treated within 24 hours developed pneumonia postoperatively. In this study population, the only risk factor for mortality was the preoperative condition of the patient.
Postoperative pneumonia occurred less frequently in patients with hip fracture who underwent surgery within 24 hours. Postoperative mortality was related to poor patient condition but not the timing of surgery. Early surgery should be avoided in patients with severe comorbidity who are not optimally prepared for surgery.
评估与延迟手术相比，在24小时内接受手术（这已被宣传为优质护理的一项指标）的髋部骨折患者是否具有降低的死亡风险和并发症风险。
基于前瞻性设计的电子病历进行的回顾性现状研究。
收集2000年1月1日至2003年12月31日期间因髋部骨折入住荷兰乌得勒支大学医学中心的年龄≥60岁患者的数据。对在24小时内接受手术的患者和24小时后接受手术的患者的结局进行比较。主要结局指标是死亡率（住院期间、出院后3个月、1年和3年）。次要结局指标是术后并发症、术后住院时间和入住长期护理机构情况。我们对年龄、性别和术前合并症进行了校正。
共纳入217例患者。在24小时内接受手术的150例患者中，平均年龄为80.5岁，75%为女性，根据美国麻醉医师协会（ASA）分级，28%为Ⅲ或Ⅳ级。在24小时后接受手术的67例患者中，平均年龄为80.9岁，82%为女性，49%为ASAⅢ或Ⅳ级。在校正已公布的风险因素后，手术时间与死亡率之间没有关系。24小时内接受治疗的患者术后发生肺炎的较少。在本研究人群中，唯一的死亡风险因素是患者的术前状况。
24小时内接受手术的髋部骨折患者术后肺炎发生率较低。术后死亡率与患者状况不佳有关，而非手术时间。对于未做好最佳手术准备的严重合并症患者，应避免早期手术。
