Wong Siu Him Janus, Fang Xinshuo Christian, Yee King Hang Dennis, Wong Tak Man, Pun Cheuk Ting Terence, Lau Tak Wing, Leung Ka Li Frankie
Department of Orthopaedics & Traumatology, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China.
Department of Orthopaedics & Traumatology, University of Hong Kong, 102 Pokfulam Road, Hong Kong, China.
Int Orthop. 2018 Aug;42(8):1789-1794. doi: 10.1007/s00264-017-3737-2. Epub 2018 Jan 3.
The association between delayed hip fracture surgery and mortality remains elusive because of strong confounding by comorbidity factors. We designed a study to investigate the effect of small delays in surgery due to holidays.
Consecutive hip fractures operated in a high-income, publicly funded healthcare system between 2006 and 2013 were analysed. Age <65 years, pathological fractures, history of previous hip operation and time to surgery >seven days were excluded. Patients were grouped according to number of holidays following admission (HFA) as a surrogate for time to surgery, with difference in mean time to surgery tested for statistical significance and baseline characteristics including age, sex, Charlson comorbidity index (CCI) and fracture and operation types assessed. Survival up to two years was compared.
Thirty-one thousand five hundred and ninety-two patients were included. Patient groups with zero, one, two or three HFA had significantly different mean time to operation of 2.25, 2.47, 2.67 and 2.84 days, respectively (Kruskal-Wallis test p < 0.0001), but baseline characteristics were similar. There was no difference in mortality at six months (p = 0.431) and two years (p = 0.785). Cox's regression analysis identified age, gender and CCI as independent predictors of mortality but not HFA, and the adjusted hazards ratio for each HFA increment was 1.026 [95% confidence interval (CI) 0.999-1.025; p = 0.056] which was not statistically significant.
We observed no increase in mortality rate in patients having small delays in surgery because of holidays.
由于合并症因素的强烈混杂作用，延迟髋部骨折手术与死亡率之间的关联仍不明确。我们设计了一项研究来调查因节假日导致的手术小幅延迟的影响。
分析了2006年至2013年在一个高收入、公共资助的医疗保健系统中接受手术的连续性髋部骨折病例。排除年龄<65岁、病理性骨折、既往髋部手术史以及手术时间>7天的患者。根据入院后节假日数量（HFA）对患者进行分组，以此作为手术时间的替代指标，检验平均手术时间的差异是否具有统计学意义，并评估包括年龄、性别、Charlson合并症指数（CCI）以及骨折和手术类型在内的基线特征。比较了两年内的生存率。
共纳入31592例患者。HFA为零、一、二或三个的患者组平均手术时间分别为2.25、2.47、2.67和2.84天，差异有统计学意义（Kruskal-Wallis检验p<0.0001），但基线特征相似。六个月时（p=0.431）和两年时（p=0.785）的死亡率无差异。Cox回归分析确定年龄、性别和CCI是死亡率的独立预测因素，但HFA不是，且每增加一个HFA的调整风险比为1.026[95%置信区间（CI）0.999-1.025；p=0.056]，无统计学意义。
我们观察到因节假日导致手术小幅延迟的患者死亡率没有增加。
