Cha Yong-Han, Ha Yong-Chan, Yoo Jun-Il, Min Yeon-Seung, Lee Young-Kyun, Koo Kyung-Hoi
Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, South Korea.
Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, South Korea.
Arch Orthop Trauma Surg. 2017 May;137(5):625-630. doi: 10.1007/s00402-017-2674-2. Epub 2017 Mar 20.
The purpose of this study was to investigate the reasons for delayed surgery in patients with proximal hip fracture and to compare differences in mortality between delayed surgery cases and non-delayed surgery cases. In addition, we evaluated causal factors for delayed surgery that affected differences in mortality.
From 2003 to 2013, 1290 patients (1290 hips) with unilateral femoral neck or intertrochanteric fractures who underwent surgery were categorized into Group Ia (402 patients, early surgery group) and Group Ib (888 patients, delayed surgery group). The delayed surgery group was categorized as Group IIa (270 patients, pre-hospital delay group) and Group IIb (618 patients, post-hospital delay group). Among 618 patients with post-hospital delay, 165 patients in Group IIIa were defined as delayed surgery cases due to patient factors, and 453 patients in Group IIIB were defined as delayed surgery cases due to hospital factors. Early and late mortality was compared between each group.
Of 1290 patients, 888 patients underwent delayed surgery (mean 7.5 days, range 3-167 days) after hip fracture. The cumulative mortality rate at 30, 60 days, 3, and 12 months was 0.7, 2.0, 3.0, and 9.5% in Group Ia, respectively, and 2.4, 4.5, 5.2, and 14.5% in Group Ib, respectively (p = 0.047, p = 0.027, p = 0.078, and p = 0.012, respectively). Of 618 patients with post-hospital surgery delay, the cumulative mortality rate at 30 days and 12 months was 4.8 and 21.2% in Group IIIa, respectively, and 1.8, and 12.6% in Group IIIb, respectively (p = 0.033 and p = 0.008, respectively). After adjustments, patient factors for delayed surgery (HR 2.780; 95% CI 1.012-7.640, p = 0.047) were significantly associated with death after hip fracture.
This study demonstrated that delayed surgery was significantly related to 30-day and 1-year mortality. Surgery delay due to drugs' hold and medical comorbidity was related to 30-day mortality after adjustment.
本研究的目的是调查近端髋部骨折患者手术延迟的原因，并比较延迟手术病例与非延迟手术病例的死亡率差异。此外，我们评估了影响死亡率差异的延迟手术的因果因素。
2003年至2013年，1290例接受单侧股骨颈或转子间骨折手术的患者（1290髋）被分为Ia组（402例，早期手术组）和Ib组（888例，延迟手术组）。延迟手术组又分为IIa组（270例，院前延迟组）和IIb组（618例，院后延迟组）。在618例院后延迟患者中，IIIa组的165例患者被定义为因患者因素导致的延迟手术病例，IIIB组的453例患者被定义为因医院因素导致的延迟手术病例。比较各组的早期和晚期死亡率。
1290例患者中，888例在髋部骨折后接受了延迟手术（平均7.5天，范围3 - 167天）。Ia组30天、60天、3个月和12个月时的累积死亡率分别为0.7%、2.0%、3.0%和9.5%，Ib组分别为2.4%、4.5%、5.2%和14.5%（p分别为0.047、0.027、0.078和0.012）。在618例院后手术延迟的患者中，IIIa组30天和12个月时的累积死亡率分别为4.8%和21.2%，IIIB组分别为1.8%和12.6%（p分别为0.033和0.008）。调整后，延迟手术的患者因素（HR 2.780；95%CI 1.012 - 7.640，p = 0.047）与髋部骨折后的死亡显著相关。
本研究表明，延迟手术与30天和1年死亡率显著相关。调整后，因药物停用和合并症导致的手术延迟与30天死亡率相关。
