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内科与矫形外科服务在髋部骨折医院管理中的比较。

Medicine versus orthopaedic service for hospital management of hip fractures.

机构信息

Division of General Internal Medicine, Penn State College of Medicine, Hershey, PA, USA.

出版信息

Clin Orthop Relat Res. 2010 Aug;468(8):2218-23. doi: 10.1007/s11999-010-1290-z. Epub 2010 Mar 12.

Abstract

BACKGROUND

Hospital care of patients with hip fractures often is managed primarily by either a medicine or orthopaedic service, depending on the institution. Whether complication rates, length of stay, or time to surgery differs on different services is unknown.

QUESTIONS/PURPOSES: We therefore determined whether (1) perioperative complication rates, and (2) length of stay and time to surgery for patients undergoing surgical management of hip fractures differed by the specialty of the primary service.

PATIENTS AND METHODS

We performed a retrospective cohort study at a university-based academic hospital of patients undergoing surgery for hip fracture admitted to medicine and orthopaedic services during 2006. Of the 98 patients included in the analysis, 34% were managed by a medicine service and 66% by orthopaedics. Using multivariable regression models to adjust for patient characteristics and comorbidities, we determined whether service designation predicted the likelihood of severe or intermediate perioperative complications, length of stay, or time to surgery.

RESULTS

The rate of severe or intermediate complications for patients undergoing surgical management of hip fractures was 30%. Patients with medicine or orthopaedic services did not differ in the rate of severe or intermediate complications or length of stay in adjusted analysis. However, time to surgery was longer in patients managed by the medical service in adjusted analysis.

CONCLUSIONS

In our patient cohort, the likelihood of perioperative complications occurring among patients with hip fractures did not differ by service designation in adjusted analysis.

LEVEL OF EVIDENCE

Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

摘要

背景

患者髋部骨折的医院治疗通常主要由内科或骨科服务管理,具体取决于机构。不同服务的并发症发生率、住院时间和手术时间是否存在差异尚不清楚。

问题/目的:因此,我们确定(1)围手术期并发症发生率,以及(2)接受髋部骨折手术治疗的患者的住院时间和手术时间是否因主要服务的专业而有所不同。

患者和方法

我们在一所大学附属医院进行了一项回顾性队列研究,研究对象为 2006 年接受髋部骨折手术的内科和骨科服务患者。在纳入分析的 98 例患者中,34%由内科服务管理,66%由骨科服务管理。我们使用多变量回归模型调整患者特征和合并症,以确定服务指定是否预测严重或中度围手术期并发症、住院时间或手术时间的可能性。

结果

接受髋部骨折手术治疗的患者严重或中度并发症的发生率为 30%。在调整分析中,接受内科或骨科服务的患者严重或中度并发症发生率或住院时间无差异。然而,在调整分析中,接受内科服务管理的患者手术时间更长。

结论

在我们的患者队列中,髋部骨折患者的围手术期并发症发生可能性在调整分析中不因服务指定而有所不同。

证据水平

二级,预后研究。有关证据水平的完整描述,请参见作者指南。

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本文引用的文献

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