Richards T, Glendenning A, Benson D, Alexander S, Thati S
Trauma and Orthopaedic Department, Ysbyty Gwynedd , Bangor, Wales , UK.
Swansea University Medical School , Swansea, Wales , UK.
Ann R Coll Surg Engl. 2018 Sep;100(7):556-562. doi: 10.1308/rcsann.2018.0068. Epub 2018 Apr 25.
Introduction Management of hip fractures has evolved over recent years to drive better outcomes including length of hospital stay. We aimed to identify and quantify the effect that patient factors influence acute hospital and total health service length of stay. Methods A retrospective observational study based on National Hip Fracture Database data was conducted from 1 January 2014 to 31 December 2015. A multiple regression analysis of 330 patients was carried out to determine independent factors that affect acute hospital and total hospital length of stay. Results American Society of Anesthesiologists (ASA) grade 3 or above, Abbreviated Mental Test Score (AMTS) less than 8 and poor mobility status were independent factors, significantly increasing length of hospital stay in our population. Acute hospital length of stay can be predicted as 8.9 days longer when AMTS less than 8, 4.2 days longer when ASA grade was 3 or above and 20.4 days longer when unable to mobilise unaided (compared with independently mobile individuals). Other factors including total hip replacement compared with hemiarthroplasty did not independently affect length of stay. Conclusions Our analysis in a representative and generalisable population illustrates the importance of identifying these three patient characteristics in hip fracture patients. When recognised and targeted with orthogeriatric support, the length of hospital stay for these patients can be reduced and overall hip fracture care improved. Screening on admission for ASA grade, AMTS and mobility status allows prediction of length of stay and tailoring of care to match needs.
引言 近年来，髋部骨折的管理方式不断演变，以实现包括缩短住院时间在内的更好治疗效果。我们旨在确定并量化患者因素对急性住院时间和整个医疗服务住院时间的影响。方法 基于国家髋部骨折数据库的数据，于2014年1月1日至2015年12月31日进行了一项回顾性观察研究。对330例患者进行多元回归分析，以确定影响急性住院时间和总住院时间的独立因素。结果 美国麻醉医师协会（ASA）3级及以上、简易精神状态检查表（AMTS）得分低于8分以及行动能力差是独立因素，显著延长了我们研究人群的住院时间。当AMTS低于8分时，急性住院时间预计延长8.9天；当ASA分级为3级及以上时，延长4.2天；当无法独立活动时（与能够独立活动的个体相比），延长20.4天。其他因素，包括全髋关节置换术与半髋关节置换术相比，并未独立影响住院时间。结论 我们在具有代表性且可推广的人群中进行的分析表明，识别髋部骨折患者的这三个患者特征非常重要。当认识到这些特征并提供老年骨科支持时，这些患者的住院时间可以缩短，髋部骨折的整体护理也可以得到改善。入院时对ASA分级、AMTS和行动能力状态进行筛查，可以预测住院时间并根据需求调整护理。
