Bosma E, de Jongh M A C, Verhofstad M H J
St Elisabeth Hospital, Tilburg, The Netherlands.
J Bone Joint Surg Br. 2010 Jan;92(1):110-5. doi: 10.1302/0301-620X.92B1.22671.
This retrospective cohort study was conducted to investigate whether operative treatment of patients with a pertrochanteric femoral fracture outside working hours is associated with an increased risk of complications and higher mortality. During the study period 165 patients were operated on outside working hours and 123 were operated on during working hours (08.00 to 17.00). There was no difference in the rate of early complications (outside working hours 33% versus working hours 33%, p = 0.91) or total complications during follow-up (outside working hours 40% versus working hours 41%, p = 0.91). Both in-hospital mortality (outside working hours 12% versus working hours 11%, p = 0.97) and mortality after one year (outside working hours 29% versus working hours 27%, p = 0.67) were comparable. Adjustment for possible confounders by multivariate logistic regression analysis revealed no increased risk of complications when patients were operated on outside working hours. On the basis of these data, there is no medical reason to postpone operative reduction and fixation in patients with a proximal femoral fracture until working hours.
本回顾性队列研究旨在调查非工作时间对股骨转子间骨折患者进行手术治疗是否会增加并发症风险及死亡率。研究期间，165例患者在非工作时间接受手术，123例患者在工作时间（08:00至17:00）接受手术。早期并发症发生率（非工作时间为33%，工作时间为33%，p = 0.91）或随访期间的总并发症发生率（非工作时间为40%，工作时间为41%，p = 0.91）均无差异。院内死亡率（非工作时间为12%，工作时间为11%，p = 0.97）和一年后的死亡率（非工作时间为29%，工作时间为27%，p = 0.67）也相当。通过多因素逻辑回归分析对可能的混杂因素进行校正后发现，非工作时间对患者进行手术治疗不会增加并发症风险。基于这些数据，没有医学理由将股骨近端骨折患者的手术复位和固定推迟至工作时间。
