Kristensen Pia K, Thillemann Theis M, Johnsen Søren P
*Department of Orthopedic Surgery, Hospital Horsens, Sundvej, Horsens †Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark.
Med Care. 2014 Dec;52(12):1023-9. doi: 10.1097/MLR.0000000000000234.
Higher patient volume has been linked with better clinical outcomes for a range of surgical procedures; however, little is known about the impact of volume on quality of care and clinical outcome among patients with hip fracture.
To examine the association between hip fracture patient volume and 30-day mortality, quality of in-hospital care, time to surgery, and length of hospital stay, respectively.
Population-based follow-up study.
Using prospectively collected data from the Danish Multidisciplinary Hip Fracture Registry, we identified 12,065 patients 65 years and older who were admitted with a hip fracture between March 1, 2010 and November 30, 2011.
Patient volume was divided into 3 groups; ≤ 151 hip fracture admissions per year, 152-350, and ≥ 351 admissions per year based on the distribution of the hospitals and to ensure a reasonable proportion of hospitals in each category. Data were analyzed using regression techniques while controlling for potential confounders.
Admission to high-volume units was associated with higher 30-day mortality [adjusted odds ratio (OR)=1.37 (95% confidence interval (CI), 1.14-1.64)] and a longer length of hospital stay (adjusted relative time=1.25 (95% CI, 1.02-1.52)]. Furthermore, patients had lower odds for being mobilized within 24 hours postoperatively and for receiving basic mobility assessment and a postdischarge rehabilitation program. Time to surgery was nonsignificantly increased [adjusted relative time=1.25 (95% CI, 0.99-1.58)].
Patients admitted to high-volume hip fracture units had higher mortality rates, received a lower quality of in-hospital care, and had longer length of hospital stay.
对于一系列外科手术而言，较高的患者数量与更好的临床结局相关；然而，关于手术量对髋部骨折患者护理质量和临床结局的影响却知之甚少。
分别研究髋部骨折患者数量与30天死亡率、住院护理质量、手术时间以及住院时长之间的关联。
基于人群的随访研究。
利用丹麦多学科髋部骨折登记处前瞻性收集的数据，我们确定了2010年3月1日至2011年11月30日期间因髋部骨折入院的12065名65岁及以上的患者。
根据医院分布将患者数量分为3组；每年髋部骨折入院人数≤151例、152 - 350例以及≥351例，以确保每组中有合理比例的医院。在控制潜在混杂因素的同时，使用回归技术对数据进行分析。
入住高手术量科室与较高的30天死亡率[调整优势比(OR)=1.37(95%置信区间(CI)，1.14 - 1.64)]以及较长的住院时长(调整相对时间=1.25(95%CI，1.02 - 1.52))相关。此外，患者术后24小时内活动的几率较低，接受基本活动能力评估和出院后康复计划的几率也较低。手术时间虽有增加，但无显著差异[调整相对时间=1.25(95%CI，0.99 - 1.58)]。
入住高手术量髋部骨折科室的患者死亡率较高，住院护理质量较低，住院时长较长。
