Departments of Department of General Anesthesiology, and.
Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH.
J Orthop Trauma. 2018 Mar;32(3):105-110. doi: 10.1097/BOT.0000000000001043.
To evaluate the relationship between surgical timing and 1-year mortality in patients requiring hip fracture repair.
We analyzed all 720 patients (>65 years) who had hip fracture surgery between March 2005 and February 2015, identifying patients by ICD-9 diagnosis and procedure codes using electronic data query. Mortality data were obtained from the institutional database, state and Social Security Death Indices. The relationship between surgical timing (defined as the interval from admission to the start of surgery) and 1-year mortality was assessed using a multivariable logistic regression, adjusting for baseline clinical status and surgical factors.
Among the 720 patients, 159 patients (22%) died within 1 year. The median time from admission to surgery was 30 hours. A linear relationship between the surgical timing and 1-year mortality was demonstrated. Delaying surgery was significantly associated with increased 1-year mortality, odds ratio 1.05 (95% CI: 1.02-1.08) per 10-hour delay (P = 0.001).
A linear relationship was observed between surgical timing and 1-year mortality. Each 10-hour delay from admission to surgery was associated with an estimated 5% higher odds of 1-year mortality. Therefore, we suggest that hip fractures should be treated urgently similar to other time-sensitive pathology such as stroke and myocardial ischemia.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
评估髋部骨折修复患者手术时机与 1 年死亡率的关系。
我们分析了 2005 年 3 月至 2015 年 2 月期间所有 720 例（>65 岁）接受髋部骨折手术的患者，通过电子数据查询使用 ICD-9 诊断和手术代码识别患者。死亡率数据来自机构数据库、州和社会安全死亡指数。使用多变量逻辑回归评估手术时机（定义为从入院到手术开始的时间间隔）与 1 年死亡率之间的关系，并调整基线临床状况和手术因素。
在 720 例患者中，159 例（22%）在 1 年内死亡。从入院到手术的中位时间为 30 小时。手术时机与 1 年死亡率之间呈线性关系。手术延迟与 1 年死亡率显著相关，每延迟 10 小时，比值比为 1.05（95%CI：1.02-1.08）（P = 0.001）。
手术时机与 1 年死亡率之间存在线性关系。从入院到手术的每延迟 10 小时，估计 1 年死亡率增加 5%。因此，我们建议髋部骨折应像其他时间敏感的病理情况（如中风和心肌缺血）一样紧急治疗。
预后 III 级。有关证据水平的完整描述，请参见作者说明。
