Geriatric Unit, Department of Neurological and Mobility Sciences Arcispedale Santa Maria Nuova, Viale Risorgimento 80, Reggio Emilia, Italy.
Arch Gerontol Geriatr. 2012 Sep-Oct;55(2):316-22. doi: 10.1016/j.archger.2011.11.010. Epub 2011 Dec 15.
To compare the pathways of care and clinical results for patients admitted for hip fracture (HF) in 3 orthogeriatric co-managed care centers in order to estimate the effect of system factors on mortality and functional outcome.
Prospective inception multicenter cohort study.
Three tertiary Hospitals.
806 patients consecutively admitted with HF.
1-Year mortality, the loss of 1 or more functional abilities in activities of daily living (ADLs), and the recovery/maintenance of independent ambulation at 6 months from the fracture.
On the whole sample, 71.1% of patients survived 1 year from the fracture. In one hospital the risk of 1-year mortality was significantly higher even after adjusting for age, sex, comorbidity, prefracture functional status and cognitive impairment (odd ratio (OR) 1.56, 95% confidence interval (CI) 1.15-2.18, p=0.01). This was principally explained by a longer time to surgery (5.2 days ± 3.2 vs 2.7 ± 2.3 and 2.7 ± 2.2, p<0.001). The three hospitals also differed in the rate of subjects losing the ability in ADLs after 6 months from the fracture (54.2%, 61%, 43.5%, p=0.016), while no statistical differences were found in the recovery of independent ambulation. On the basis of multivariate models, a lower access to post-acute rehabilitation could account for lower outcome in functional status.
This study suggests that system factors such as time to surgery and rehabilitation resources can affect functional recovery and 1-year mortality in orthogeriatric units and they could explain different outcomes when comparing care models.
比较 3 家骨科老年共管理护理中心收治的髋部骨折（HF）患者的治疗路径和临床结果，以评估系统因素对死亡率和功能结局的影响。
前瞻性定群多中心队列研究。
3 家三级医院。
连续收治的 806 例 HF 患者。
1 年死亡率、1 项或多项日常生活活动（ADL）功能丧失以及骨折后 6 个月独立行走的恢复/维持情况。
整体样本中，71.1%的患者在骨折后 1 年内存活。在 1 家医院，即使在调整年龄、性别、合并症、骨折前功能状态和认知障碍后，1 年死亡率的风险仍然显著更高（比值比[OR]1.56，95%置信区间[CI]1.15-2.18，p=0.01）。这主要是由于手术时间更长（5.2 天±3.2 与 2.7±2.3 和 2.7±2.2，p<0.001）。这 3 家医院在骨折后 6 个月失去 ADL 能力的患者比例也存在差异（54.2%、61%、43.5%，p=0.016），而独立行走能力的恢复没有统计学差异。基于多变量模型，获得急性后康复的机会较少可能是功能状态较差的原因。
本研究表明，手术时间和康复资源等系统因素可能会影响骨科老年病房的功能恢复和 1 年死亡率，并且在比较护理模式时可以解释不同的结果。
