Morrissey Natasha, Iliopoulos Efthymios, Osmani Ahmad Wais, Newman Kevin
Rowley Bristow Unit, St Peters Hospital, Guildford Road, Chertsey, KT16 0PZ, United Kingdom.
Rowley Bristow Unit, St Peters Hospital, Guildford Road, Chertsey, KT16 0PZ, United Kingdom.
Injury. 2017 Jun;48(6):1155-1158. doi: 10.1016/j.injury.2017.03.007. Epub 2017 Mar 6.
To determine if early surgery before 12h confers a survival or length of stay benefit for patients with neck of femur (NOF) fractures.
Retrospective review of prospectively collected data.
District general hospital.
1913 patients aged over 60 admitted with a fractured NOF who underwent surgery between 2011 and 2015. Mean age was 83.9 years. 73.7% were female.
Patients had surgery for fractured NOF with data collected on demographics, mortality and length of stay.
Data collected included gender, age, ASA grade, fracture anatomy, surgery, time to surgery, days spent in acute hospital and rehabilitation settings and 30-day mortality. Statistical analysis was used to identify independent predictors of mortality and length of stay.
30-day mortality was 6.1% and the mean hospitalisation time was 13±11.3days for the acute hospital and 20.2±17.2days for the trust. Operations were performed at a mean of 23.8±14.8h after presentation. Age, gender, ASA grade and type of fracture were independent predictors of either mortality or length of stay. Timing of surgery had an association with mortality but this only reached statistical significance at 24h. In line with previous studies we analysed time to surgery in 12h blocks. We also used logistic regression, recognizing time as a continuous variable, which revealed that every hour of delay to surgery increased the mortality risk by 1.8%.
While every hour of delay increased mortality risk, the association with mortality only became statistically significant when delaying over 24h. This supports a pragmatic approach, with surgery as soon as medically possible without a race to theatre.
Level III retrospective cohort study.
确定股骨颈（NOF）骨折患者在12小时内进行早期手术是否能带来生存获益或缩短住院时间。
对前瞻性收集的数据进行回顾性分析。
地区综合医院。
1913例60岁以上因NOF骨折入院并于2011年至2015年间接受手术的患者。平均年龄为83.9岁。73.7%为女性。
对NOF骨折患者进行手术，并收集人口统计学、死亡率和住院时间等数据。
收集的数据包括性别、年龄、美国麻醉医师协会（ASA）分级、骨折部位、手术情况、手术时间、在急症医院和康复机构的住院天数以及30天死亡率。采用统计分析确定死亡率和住院时间的独立预测因素。
30天死亡率为6.1%，急症医院的平均住院时间为13±11.3天，信托机构的平均住院时间为20.2±17.2天。患者就诊后平均23.8±14.8小时进行手术。年龄、性别、ASA分级和骨折类型是死亡率或住院时间的独立预测因素。手术时间与死亡率有关，但仅在24小时时达到统计学意义。与以往研究一致，我们以12小时为时间段分析手术时间。我们还使用逻辑回归，将时间视为连续变量，结果显示手术每延迟一小时，死亡风险增加1.8%。
虽然每延迟一小时死亡风险都会增加，但只有在延迟超过24小时时，与死亡率的关联才具有统计学意义。这支持了一种务实的方法，即在医疗条件允许的情况下尽快进行手术，而不是争分夺秒地送往手术室。
III级回顾性队列研究。
