Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, Iowa.
J Arthroplasty. 2017 Nov;32(11):3314-3318. doi: 10.1016/j.arth.2017.07.023. Epub 2017 Jul 25.
The purpose of this study is to (1) identify the incidence of surgical delay in hip fractures, (2) evaluate the time point surgical delay puts patients at increased risk for complications, and (3) identify risk factors for surgical delay in the setting of surgical management of hip fractures.
A multi-center database was queried for patients of 60 years of age or older undergoing surgical treatment of a hip fracture. Surgical delay was defined by days from admission until surgical intervention. Univariate analyses and multivariate analyses were performed on all groups.
A total of 4215 patients underwent surgery for their hip fracture. Of those experiencing surgical delay, 3304 (78%) patients experienced surgical delay of ≥1 day, 1314 (31%) had delay of ≥2 days, and 480 (11%) experienced delay of ≥3 days. There was a significant difference in complications if patients experienced surgical delay of ≥2 days (P ≤ .01). Multivariate analyses identified multiple risk factors for delay of ≥2 days including congestive heart failure (odds ratio 3.09, 95% confidence interval 2.04-4.66) and body mass index ≥40 (odds ratio 2.31, 95% confidence interval 1.31-4.08). Subgroup analysis identified that patients undergoing total hip arthroplasty were not at risk for complications with surgical delay of ≥2 days.
Surgical delay of ≥2 days in the setting of hip fractures is common and confers an increased risk of complications in those undergoing non-total hip arthroplasty procedures. We recommend surgical intervention prior to 48 hours from hospital admission when possible. Healthcare systems can utilize our non-modifiable risk factors when performing quality assessment and cost accounting.
本研究旨在：(1) 确定髋部骨折手术延迟的发生率；(2) 评估手术延迟使患者发生并发症的风险增加的时间点；(3) 在髋部骨折手术治疗的情况下，确定手术延迟的危险因素。
对接受髋部骨折手术治疗的 60 岁及以上患者的多中心数据库进行了查询。手术延迟定义为从入院到手术干预的天数。对所有组进行了单因素分析和多因素分析。
共有 4215 例患者因髋部骨折接受手术治疗。在经历手术延迟的患者中，3304 例(78%)患者的手术延迟≥1 天，1314 例(31%)患者的手术延迟≥2 天，480 例(11%)患者的手术延迟≥3 天。如果患者经历手术延迟≥2 天，并发症的发生率存在显著差异(P≤0.01)。多因素分析确定了≥2 天延迟的多个危险因素，包括充血性心力衰竭(比值比 3.09，95%置信区间 2.04-4.66)和体重指数≥40(比值比 2.31，95%置信区间 1.31-4.08)。亚组分析确定，接受全髋关节置换术的患者在手术延迟≥2 天的情况下，不会增加并发症的风险。
髋部骨折手术延迟≥2 天较为常见，且在非全髋关节置换术患者中增加了并发症的风险。我们建议在入院后 48 小时内尽可能进行手术干预。医疗保健系统在进行质量评估和成本核算时，可以使用我们无法改变的危险因素。
