Pedersen Susanne J, Borgbjerg Finn M, Schousboe Birgitte, Pedersen Bente D, Jørgensen Henrik L, Duus Benn R, Lauritzen Jes B
Department Orthopedic Surgery, Health Science Faculty, Bispebjerg Hospital, University of Copenhagen, University of Copenhagen, Copenhagen, Denmark.
J Am Geriatr Soc. 2008 Oct;56(10):1831-8. doi: 10.1111/j.1532-5415.2008.01945.x.
To evaluate the rate of postoperative complications, length of stay, and 1-year mortality before and after introduction of a comprehensive multidisciplinary fast-track treatment and care program for hip fracture patients (the optimized program).
Retrospective chart review with historical control.
Orthopedic ward (110 beds) at a university hospital (700 beds).
Five hundred thirty-five consecutive patients aged 40 and older (94%>or=60) hospitalized for hip fracture between January 1, 2003, and March 31, 2004. Three hundred and thirty-six patients (70.3%) were community dwellers before the fracture and 159 (29.7%) were admitted from nursing homes.
The fast-track treatment and care program included a switch from systemic opiates to a local femoral nerve catheter block; an earlier assessment by the anesthesiologist; and a more-systematic approach to nutrition, fluid and oxygen therapy, and urinary retention.
In the intervention group, the rate of any in-hospital postoperative complication was reduced from 33% to 20% (odds ratio=0.61, 95% confidence interval=0.4-0.9; P=.002). Rates of confusion (P=.02), pneumonia (P=.03), and urinary tract infection (P<.001) were lower in the intervention group than in the control group, and length of stay was 15.8 days in the control group, versus 9.7 days in the intervention group (P<.001). For community dwellers, 12-month mortality was 23% in the control group versus 12% in the intervention group (P=.02). Overall 12-month mortality was 29% in the control group and 23% in the intervention group (P=.2).
The optimized hip fracture program reduced the rate of in-hospital postoperative complications and mortality. Randomized clinical trials are needed to confirm these results and elucidate the elements of the program that have the greatest effect on clinical outcomes and mortality.
评估针对髋部骨折患者引入综合多学科快速康复治疗与护理方案（优化方案）前后的术后并发症发生率、住院时间及1年死亡率。
采用历史对照的回顾性病历审查。
一所拥有700张床位的大学医院的骨科病房（110张床位）。
2003年1月1日至2004年3月31日期间因髋部骨折住院的535例40岁及以上患者（94%≥60岁）。骨折前336例患者（70.3%）为社区居民，159例（29.7%）来自养老院。
快速康复治疗与护理方案包括从全身使用阿片类药物改为局部股神经导管阻滞；麻醉医生更早进行评估；以及对营养、液体和氧气治疗及尿潴留采取更系统的方法。
干预组中，任何院内术后并发症的发生率从33%降至20%（优势比=0.61，95%置信区间=0.4 - 0.9；P = 0.002）。干预组的意识混乱发生率（P = 0.02）、肺炎发生率（P = 0.03）和尿路感染发生率（P < 0.001）均低于对照组，对照组的住院时间为15.8天，而干预组为9.7天（P < 0.001）。对于社区居民，对照组的12个月死亡率为23%，干预组为12%（P = 0. = 0.02）。总体12个月死亡率对照组为29%，干预组为23%（P = 0.2）。
优化的髋部骨折方案降低了院内术后并发症发生率和死亡率。需要进行随机临床试验以证实这些结果，并阐明该方案中对临床结局和死亡率影响最大的因素。
