Trpeski Simon, Kaftandziev Igor, Kjaev Aleko
University Traumatology Clinic, Medical Faculty, Ss. Cyril and Methodius University, Skopje, R. Macedonia.
Pril (Makedon Akad Nauk Umet Odd Med Nauki). 2013;34(2):115-21.
Mortality occurring as a consequence of hip fracture in older patients is very high. Mortality is highest in the first few months after the injury, and this rate is kept at a high level within the first six months postoperatively. Current guidelines indicate that surgery should be performed within 48 hours of injury because early surgery is associated with lower rates of perioperative complications and mortality.
To analyse the effects of time-to-surgery on mortality in elderly patients with hip fracture.
The research was conducted at the University Traumatology Clinic in Skopje, where 120 patients with hip fracture of age 65 and above were treated. The age span was 55-95 years, with a mean age of 73.9±9.8 years. The time frame for the research and the follow-up of the patients was 6 months. Inclusion criteria included patients aged above 65 and isolated proximal femur fractures. Survival time for patients after six months was determined with the Kaplan-Meier product-limit method. Statistical significance was evaluated at level of p<0.05.
The mean time from patient admission to surgical intervention was 3.07±1.5 days (range 0-6 days). Hospitalization time averaged 11±4.7 days. We separated our patient population into two groups, one consisting of patients operated in the first two days, the other after two days. The patient death rate in the first group of 25 patients operated in the first 48 hours was a total of 4 patients (16%) after 6 months. The second group, 95 patients operated after 48 hours, showed a significant rise in mortality--32 patients (33.7%). The mean survival time of patients operated within 48 hours is 168.8 days, while the mean survival time of patients operated after 48 hours from their hospital admission was 143.6 days.
Delay in surgery is associated with significant increase in mortality. Patients should have their operation as soon as possible after admission to hospital, preferably in the first 48 hours.
老年患者因髋部骨折导致的死亡率非常高。死亡率在受伤后的最初几个月最高，且在术后的前六个月内一直维持在较高水平。当前指南指出，手术应在受伤后48小时内进行，因为早期手术与围手术期并发症和死亡率较低相关。
分析手术时间对老年髋部骨折患者死亡率的影响。
研究在斯科普里大学创伤诊所进行，共治疗了120例65岁及以上的髋部骨折患者。年龄跨度为55 - 95岁，平均年龄为73.9±9.8岁。研究及患者随访时间为6个月。纳入标准包括65岁以上且孤立的股骨近端骨折患者。采用Kaplan - Meier乘积限界法确定患者六个月后的生存时间。统计学显著性评估水平为p<0.05。
患者入院至手术干预的平均时间为3.07±1.5天（范围0 - 6天）。住院时间平均为11±4.7天。我们将患者群体分为两组，一组是在受伤后头两天内进行手术的患者；另一组是在两天后进行手术的患者。第一组在最初48小时内接受手术的25例患者，6个月后共有4例患者死亡（16%）。第二组，即48小时后接受手术的95例患者，死亡率显著上升至32例（33.7%）。48小时内接受手术的患者平均生存时间为168.8天，而入院后48小时后接受手术的患者平均生存时间为143.6天。
手术延迟与死亡率显著增加相关。患者入院后应尽快进行手术，最好在最初48小时内。
