Fu M C, Boddapati V, Gausden E B, Samuel A M, Russell L A, Lane J M
Hospital for Special Surgery, New York, USA.
Hospital for Special Surgery, Weill Cornell Medical College, New York, USA.
Bone Joint J. 2017 Sep;99-B(9):1216-1222. doi: 10.1302/0301-620X.99B9.BJJ-2017-0101.R1.
We aimed to characterise the effect of expeditious hip fracture surgery in elderly patients within 24 hours of admission on short-term post-operative outcomes.
Patients age 65 or older that underwent surgery for closed femoral neck and intertrochanteric hip fractures were identified from the American College of Surgeons National Surgical Quality Improvement Program between 2011 and 2014. Multivariable propensity-adjusted logistic regressions were performed to determine associations between early surgery within 24 hours and post-operative complications, controlling for selection bias in patients undergoing early surgery based on observable characteristics.
A total of 26 051 patients were included in the study; 5921 (22.7%) had surgery within 24 hours of admission, while 20 130 (77.3%) patients had surgery after 24 hours. Propensity-adjusted multivariable logistic regressions demonstrated that surgery within 24 hours was independently associated with lower odds of respiratory complications including pneumonia, failure to extubate, or reintubation (odds ratio (OR) 0.78, 95% confidence interval (CI) 0.67 to 0.90), and extended length of stay (LOS) defined as ≥ 6 days (OR 0.84, 95% CI 0.78 to 0.90).
In elderly patients with hip fractures, early surgery within 24 hours of admission is independently associated with less pulmonary complications including pneumonia, failure to extubate, and reintubation, as well as shorter LOS. Cite this article: 2017;99-B:1216-22.
我们旨在描述老年患者入院24小时内进行快速髋部骨折手术对术后短期结局的影响。
从美国外科医师学会国家外科质量改进计划中确定2011年至2014年间年龄在65岁及以上、接受闭合性股骨颈和转子间髋部骨折手术的患者。进行多变量倾向调整逻辑回归，以确定24小时内早期手术与术后并发症之间的关联，控制基于可观察特征接受早期手术患者的选择偏倚。
本研究共纳入26051例患者；5921例（22.7%）在入院24小时内进行了手术，而20130例（77.3%）患者在24小时后进行了手术。倾向调整后的多变量逻辑回归表明，24小时内手术与包括肺炎、拔管失败或再次插管在内的呼吸并发症几率较低独立相关（优势比（OR）0.78，95%置信区间（CI）0.67至0.90），以及定义为≥6天的延长住院时间（LOS）（OR 0.84，95%CI 0.78至0.90）。
在老年髋部骨折患者中，入院24小时内进行早期手术与较少的肺部并发症（包括肺炎、拔管失败和再次插管）以及较短的住院时间独立相关。引用本文：2017；99-B：1216 - 22。
