入住内科或骨科对老年髋部患者的住院时间有影响吗？
Does Admission to Medicine or Orthopaedics Impact a Geriatric Hip Patient's Hospital Length of Stay?
作者信息
Greenberg Sarah E, VanHouten Jacob P, Lakomkin Nikita, Ehrenfeld Jesse, Jahangir Amir Alex, Boyce Robert H, Obremksey William T, Sethi Manish K
机构信息
The Vanderbilt Orthopaedic Institute Center for Health Policy, Nashville, TN.
出版信息
J Orthop Trauma. 2016 Feb;30(2):95-9. doi: 10.1097/BOT.0000000000000440.
OBJECTIVES
The aim of our study was to determine the association between admitting service, medicine or orthopaedics, and length of stay (LOS) for a geriatric hip fracture patient.
DESIGN
Retrospective.
SETTING
Urban level 1 trauma center.
PATIENTS/PARTICIPANTS: Six hundred fourteen geriatric hip fracture patients from 2000 to 2009.
INTERVENTIONS
Orthopaedic surgery for geriatric hip fracture.
MAIN OUTCOME MEASUREMENTS
Patient demographics, medical comorbidities, hospitalization length, and admitting service. Negative binomial regression used to determine association between LOS and admitting service.
RESULTS
Six hundred fourteen geriatric hip fracture patients were included in the analysis, of whom 49.2% of patients (n = 302) were admitted to the orthopaedic service and 50.8% (3 = 312) to the medicine service. The median LOS for patients admitted to orthopaedics was 4.5 days compared with 7 days for patients admitted to medicine (P < 0.0001). Readmission was also significantly higher for patients admitted to medicine (n = 92, 29.8%) than for those admitted to orthopaedics (n = 70, 23.1%). After controlling for important patient factors, it was determined that medicine patients are expected to stay about 1.5 times (incidence rate ratio: 1.48, P < 0.0001) longer in the hospital than orthopaedic patients.
CONCLUSIONS
This is the largest study to demonstrate that admission to the medicine service compared with the orthopaedic service increases a geriatric hip fractures patient's expected LOS. Since LOS is a major driver of cost as well as a measure of quality care, it is important to understand the factors that lead to a longer hospital stay to better allocate hospital resources. Based on the results from our institution, orthopaedic surgeons should be aware that admission to medicine might increase a patient's expected LOS.
LEVEL OF EVIDENCE
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
目的
我们研究的目的是确定老年髋部骨折患者的收治科室（内科或骨科）与住院时间（LOS）之间的关联。
设计
回顾性研究。
地点
城市一级创伤中心。
患者/参与者：2000年至2009年期间的614例老年髋部骨折患者。
干预措施
老年髋部骨折的骨科手术。
主要观察指标
患者人口统计学特征、合并症、住院时间和收治科室。采用负二项回归确定住院时间与收治科室之间的关联。
结果
614例老年髋部骨折患者纳入分析，其中49.2%（n = 302）的患者收治于骨科，50.8%（n = 312）的患者收治于内科。骨科收治患者的中位住院时间为4.5天，而内科收治患者为7天（P < 0.0001）。内科收治患者的再入院率（n = 92，29.8%）也显著高于骨科收治患者（n = 70，23.1%）。在控制重要的患者因素后，确定内科患者的住院时间预计比骨科患者长约1.5倍（发病率比：1.48，P < 0.0001）。
结论
这是规模最大的一项研究，表明与骨科相比，内科收治老年髋部骨折患者会增加其预期住院时间。由于住院时间是成本的主要驱动因素以及优质护理的一项衡量指标，了解导致住院时间延长的因素对于更好地分配医院资源很重要。根据我们机构的研究结果，骨科医生应意识到收治到内科可能会增加患者的预期住院时间。
证据级别
治疗性三级证据。有关证据级别的完整描述，请参阅《作者须知》。
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