Department of Orthopaedics and Rehabilitation, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242, USA.
Clin Orthop Relat Res. 2012 Jun;470(6):1763-70. doi: 10.1007/s11999-011-2140-3. Epub 2011 Oct 21.
Proximal femoral fractures are common in the elderly. The best care depends on expeditious presentation, medical stabilization, and treatment of the condition.
QUESTIONS/PURPOSES: We investigated the risk of increased mortality in residents of rural communities secondary to inaccessible facilities and treatment delays.
We used Medicare Provider Analysis and Review Part A data to identify 338,092 patients with hip fractures. Each patient was categorized as residing in urban, large rural, or small rural areas. We compared the distance traveled, mortality rates, time from admission to surgery, and length of stay for patients residing in each location.
Patients in rural areas traveled substantially farther to reach their treating facility than did urban patients: mean, 34.4 miles for small rural, 14.5 miles for large rural, and 9.3 miles for urban. The adjusted odds ratios for mortality were similar but slightly better for urban patients for in-hospital mortality (small rural odds ratio, 1.05; large rural odds ratio, 1.13). Rural patients had a favorable adjusted odds ratio for 1-year mortality when compared with urban patients (small rural odds ratio, 0.93; large rural odds ratio, 0.96). Rural patients experienced no greater delay in time to surgery or longer hospital length of stay.
Although patients living in rural areas traveled a greater distance than those living in urban centers, we found no increase in time to surgery, hospital length of stay, or mortality.
Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
股骨近端骨折在老年人中很常见。最好的治疗取决于迅速的就诊、医疗稳定和病情的治疗。
问题/目的：我们研究了由于设施不可及和治疗延误，农村社区居民死亡率增加的风险。
我们使用 Medicare Provider Analysis and Review Part A 数据确定了 338092 例髋部骨折患者。每位患者分为居住在城市、大农村或小农村地区。我们比较了居住在每个地区的患者的旅行距离、死亡率、从入院到手术的时间以及住院时间。
与城市患者相比，农村地区的患者到达治疗设施的距离要远得多：小农村的平均距离为 34.4 英里，大农村为 14.5 英里，城市为 9.3 英里。住院死亡率的调整后比值相似，但城市患者的调整后比值略好（小农村比值为 1.05，大农村比值为 1.13）。与城市患者相比，农村患者的 1 年死亡率调整后比值有利（小农村比值为 0.93，大农村比值为 0.96）。农村患者在手术时间或住院时间方面没有延迟。
尽管居住在农村地区的患者比居住在城市中心的患者旅行距离更远，但我们没有发现手术时间、住院时间或死亡率的增加。
III 级，治疗研究。有关证据水平的完整描述，请参见作者指南。
