Sircar Padmini, Godkar Darshan, Mahgerefteh Shmuel, Chambers Karinn, Niranjan Selva, Cucco Robert
Department of Internal Medicine, Coney Island Hospital, Brooklyn, New York 11235, USA.
Am J Ther. 2007 Nov-Dec;14(6):508-13. doi: 10.1097/01.pap.0000249906.08602.a6.
The objectives were (1) to compare the morbidity and mortality of patients with hip fractures surgically repaired within and after 48 hours of the occurrence of fracture and (2) to establish whether timing of repair alone had a major role in determining how the patients fared after the surgical repair or whether comorbidities also affected outcomes.
The study involved the medical records of 49 patients (aged 51 to 99 years) admitted to Coney Island Hospital between January 2003 and January 2004 with a primary diagnosis of hip fracture who underwent surgical repair.
Analysis of data was done by retrospective chart review of patients admitted with the diagnosis of hip fracture to an acute care hospital setting. Follow-up continued until the patients were transferred to a rehabilitation facility for physical or occupational therapy after surgery.
The preoperative health status of each patient was assessed by cardiopulmonary risk index score, based on comorbid conditions, and postoperative outcome was determined by complications (such as bed sores, pneumonia, urinary tract infection, deep vein thrombosis, or pulmonary embolism) or death.
Patients who underwent early surgical repair (within 48 hours) had fewer postoperative complications (14.7%, as compared with 33.3% in the group undergoing surgery >48 hours after fracture). CPRI scores in the early and delayed surgery groups were also compared with regard to postoperative mortality and morbidity. It appeared that there was a higher statistical correlation between CPRI scores and complications among patients in the early surgery group (P=0.39) and an insignificant correlation among patients in the delayed surgery group (P=0.07).
Surgical repair of hip fractures within the first 48 hours was associated with better health outcomes in a nationally representative sample, as observed in an acute care facility, irrespective of comorbid conditions.
本研究目的如下：（1）比较骨折发生后48小时内及48小时后接受手术修复的髋部骨折患者的发病率和死亡率；（2）确定单纯的修复时机是否在决定患者手术修复后的预后方面起主要作用，或者合并症是否也会影响预后。
本研究纳入了2003年1月至2004年1月间入住科尼岛医院、初步诊断为髋部骨折并接受手术修复的49例患者（年龄51至99岁）的病历。
通过对入住急性护理医院、诊断为髋部骨折的患者进行回顾性病历审查来分析数据。随访持续至患者术后转至康复机构接受物理或职业治疗。
根据合并症，通过心肺风险指数评分评估每位患者的术前健康状况，并通过并发症（如褥疮、肺炎、尿路感染、深静脉血栓形成或肺栓塞）或死亡情况确定术后结局。
接受早期手术修复（48小时内）的患者术后并发症较少（14.7%，而骨折后48小时以上接受手术的组为33.3%）。还比较了早期和延迟手术组的CPRI评分与术后死亡率和发病率的关系。早期手术组患者的CPRI评分与并发症之间似乎存在更高的统计学相关性（P = 0.39），而延迟手术组患者之间的相关性不显著（P = 0.07）。
在一家急性护理机构观察到，在全国代表性样本中，髋部骨折在最初48小时内进行手术修复与更好的健康结局相关，无论合并症情况如何。
