Ventura C, Trombetti S, Pioli G, Belotti L M B, De Palma R
Regional Agency for Health and Social Care of Emilia-Romagna , Viale A. Moro, 21, Bologna, 40127, Italy.
Osteoporos Int. 2014 Nov;25(11):2591-7. doi: 10.1007/s00198-014-2803-5. Epub 2014 Jul 11.
The effect of patient characteristics and organizational and system factors on time to surgery were studied using Emilia Romagna Region database and hospital survey. The results showed that the implementation of a Hip Fracture Program significantly increased the probability of early surgery while single intervention had only slight effect
The purpose of this study is to evaluate the effect of formal Hip Fracture Program (HFP) on timing of surgery in hip fracture older patients.
This is a retrospective cohort study based on Emilia Romagna administrative databases. Data on organizational and system factor were also obtained through a hospital survey. A multilevel logistic regression analysis was carried out to assess the effect of covariates on early surgery, taking into account patient level, hospital level, and trust level variability.
From 1 January to 31 December 2011, 5,520 subjects over 65 years old underwent surgical repair for hip fracture in Emilia Romagna. The mean waiting time to surgery was 3.4 ± 12.3 days, and the overall percentage of patients operated within 2 days was 52.2%. In the adjusted multilevel logistic model, significant risk factors affecting the timing of surgical intervention at patient level were age, comorbidity, day of admission, and antiplatelet or warfarin therapy while no significant single variables were found at hospital level including dedicated operation theater, hospital volume, dedicated orthogeriatric beds, and geriatrician involvement. The most significant variable was the implementation of HFP at trust level that increased three times the probability of early surgery after adjusting for confounding variables (OR 3.216, 95% CI 0.582-6.539).
Several modifiable organizational factors may affect the proportion of patients with hip fracture undergoing early surgery. This study suggests that the development and the implementation of an evidence-based HFP at trust level are a key point of the strategy of quality of care.
利用艾米利亚-罗马涅地区数据库和医院调查研究了患者特征以及组织和系统因素对手术时间的影响。结果表明，实施髋部骨折项目显著提高了早期手术的概率，而单一干预仅有轻微效果。
本研究的目的是评估正式的髋部骨折项目（HFP）对老年髋部骨折患者手术时机的影响。
这是一项基于艾米利亚-罗马涅行政数据库的回顾性队列研究。还通过医院调查获取了组织和系统因素的数据。进行了多水平逻辑回归分析，以评估协变量对早期手术的影响，同时考虑患者层面、医院层面和信托层面的变异性。
2011年1月1日至12月31日，艾米利亚-罗马涅地区5520名65岁以上的受试者接受了髋部骨折手术修复。手术平均等待时间为3.4±12.3天，2天内接受手术的患者总体比例为52.2%。在调整后的多水平逻辑模型中，患者层面影响手术干预时机的显著风险因素包括年龄、合并症、入院日期以及抗血小板或华法林治疗，而在医院层面未发现显著的单一变量，包括专用手术室、医院规模、专用老年骨科病床和老年科医生参与情况。最显著的变量是信托层面实施HFP，在调整混杂变量后，早期手术的概率增加了两倍（比值比3.216，95%可信区间0.582 - 6.539）。
几个可改变的组织因素可能影响髋部骨折患者接受早期手术的比例。本研究表明，在信托层面制定和实施基于证据的HFP是护理质量策略的关键点。
