Karolinska Institute, Department of Clinical Sciences at Danderyd Hospital, Danderyds Sjukhus, 18288 Stockholm, Sweden.
Injury. 2012 Dec;43(12):2126-31. doi: 10.1016/j.injury.2012.05.017. Epub 2012 Jul 4.
Delayed time to surgery is associated with an increase in medical complications and delayed rehabilitation for hip-fracture patients. The aim of this study was to evaluate whether an improved fast-tracking system for hip-fracture patients can reduce waiting time to surgery. We included a consecutive series of 415 hip-fracture patients in a prospective cohort study and followed up after 3 months. The control group (n=335) fast-tracked patients from the Accident & Emergency ward (A&E) to the orthopaedic ward and then surgery. The intervention group (n=80) fast-tracked patients directly to the orthopaedic ward and surgery, bypassing the A&E. The time to surgery was mean 3 (95% confidence interval (CI) 1-5) h shorter in the intervention group and 70 patients (88%) underwent surgery within 24h compared to 250 (75%) in the control group (P=0.015). The probability for surgery ≤ 24 h remained in favour of the intervention group after adjustments for several possible confounders. We found no difference in mortality or length of stay between the groups. The incidence of adverse events was lower in the intervention group at 3 months, 28% versus 38%, but did not reach statistical significance (P=0.08). By fast-tracking hip-fracture patients straight to the orthopaedic ward, our clinic was able to decrease the mean time from arrival to start of surgery and the majority of these patients underwent surgery within 24h. We believe that this fast-track system could be used in other hospitals, in both Sweden and abroad.
手术时间延迟与髋部骨折患者的医疗并发症增加和康复延迟有关。本研究旨在评估髋部骨折患者的快速通道系统是否可以缩短手术等待时间。我们在一项前瞻性队列研究中连续纳入了 415 例髋部骨折患者，并在 3 个月后进行了随访。对照组（n=335）将患者从急诊病房（A&E）快速转运至骨科病房，然后进行手术。干预组（n=80）将患者直接快速转运至骨科病房并进行手术，绕过急诊。干预组的手术时间平均缩短 3 小时（95%置信区间（CI）1-5），80 例患者（88%）在 24 小时内进行了手术，而对照组为 250 例（75%）（P=0.015）。在调整了几个可能的混杂因素后，手术时间≤24 小时的可能性仍有利于干预组。我们发现两组之间的死亡率或住院时间没有差异。干预组在 3 个月时不良事件的发生率较低，为 28%，而对照组为 38%，但无统计学意义（P=0.08）。通过将髋部骨折患者直接快速转运至骨科病房，我们的诊所能够缩短从到达至开始手术的平均时间，而且大多数患者在 24 小时内进行了手术。我们认为这种快速通道系统可以在瑞典和国外的其他医院使用。
