Bollinger Alexander J, Butler Paul D, Nies Matthew S, Sietsema Debra L, Jones Clifford B, Endres Terrence J
Grand Rapids Medical Education Partners, Department of Orthopaedic Surgery, Grand Rapids, MI, USA ; Michigan State University College of Human Medicine, Grand Rapids, MI, USA.
Department of Orthopaedic Surgery, University of Wisconsin, Madison, WI, USA.
Geriatr Orthop Surg Rehabil. 2015 Sep;6(3):202-8. doi: 10.1177/2151458515588560.
Hip fractures have significant effects on the geriatric population and the health care system. Prior studies have demonstrated both the safety of intravenous (IV) acetaminophen and its efficacy in decreasing perioperative narcotic consumption. The purpose of this study is to evaluate the effect of scheduled IV acetaminophen for perioperative pain control on length of hospital stay, pain level, narcotic use, rate of missed physical therapy (PT) sessions, adverse effects, and discharge disposition in geriatric patients with hip fractures.
A retrospective review was performed of all patients 65 years and older admitted to a level I trauma center, who received operative treatment for a hip fracture over a 2-year period. Demographic data, in-hospital variables, and outcome measures were analyzed. Three hundred thirty-six consecutive fractures in 332 patients met inclusion criteria. These patients were divided into 2 cohorts. Group 1 (169 fractures) consisted of patients treated before the initiation of a standardized IV acetaminophen perioperative pain control protocol, and group 2 (167 fractures) consisted of those treated after the protocol was initiated.
Group 2 had a statistically significant shorter mean length of hospital stay (4.4 vs 3.8 days), lower mean pain score (4.2 vs 2.8), lower mean narcotic usage (41.3 vs 28.3 mg), lower rate of PT sessions missed (21.8% vs 10.4%), and higher likelihood of discharge home (7% vs 19%; P ≤ .001). Use of IV acetaminophen was also consistently and independently predictive of the same variables (P < .01).
The utilization of scheduled IV acetaminophen as part of a standardized pain management protocol for geriatric hip fractures resulted in shortened length of hospital stay, decreased pain levels and narcotic use, fewer missed PT sessions, and higher rate of discharge to home.
Therapeutic level III.
髋部骨折对老年人群和医疗保健系统有重大影响。既往研究已证实静脉注射（IV）对乙酰氨基酚的安全性及其在减少围手术期麻醉药物消耗方面的有效性。本研究的目的是评估计划性静脉注射对乙酰氨基酚用于围手术期疼痛控制对老年髋部骨折患者住院时间、疼痛程度、麻醉药物使用、物理治疗（PT）课程错过率、不良反应及出院处置的影响。
对一家一级创伤中心收治的所有65岁及以上、在2年期间接受髋部骨折手术治疗的患者进行回顾性研究。分析人口统计学数据、住院变量及结果指标。332例患者的336例连续骨折符合纳入标准。这些患者被分为2组。第1组（169例骨折）由在标准化静脉注射对乙酰氨基酚围手术期疼痛控制方案启动前接受治疗的患者组成，第2组（167例骨折）由在该方案启动后接受治疗的患者组成。
第2组的平均住院时间在统计学上显著缩短（4.4天对3.8天），平均疼痛评分更低（4.2对2.8），平均麻醉药物使用量更低（41.3毫克对28.3毫克），PT课程错过率更低（21.8%对10.4%），出院回家的可能性更高（7%对19%；P≤0.001）。静脉注射对乙酰氨基酚的使用也始终且独立地可预测相同变量（P<0.01）。
将计划性静脉注射对乙酰氨基酚作为老年髋部骨折标准化疼痛管理方案的一部分使用，可缩短住院时间，降低疼痛程度和麻醉药物使用量，减少错过的PT课程，并提高出院回家率。
治疗性III级。
