Alvi Hasham M, Thompson Rachel M, Krishnan Varun, Kwasny Mary J, Beal Matthew D, Manning David W
Barrington Orthopedic Specialists, Schaumburg, IL.
Am J Orthop (Belle Mead NJ). 2018 Sep;47(9). doi: 10.12788/ajo.2018.0071.
The morbidity and mortality after hip fracture in the elderly are influenced by non-modifiable comorbidities. Time-to-surgery is a modifiable factor that may play a role in postoperative morbidity. This study investigates the outcomes and complications in the elderly hip fracture surgery as a function of time-to-surgery. Using the American College of Surgeons-National Surgical Quality Improvement Program data from 2011 to 2012, a study population was generated using the Current Procedural Terminology codes for percutaneous or open treatment of femoral neck fractures (27235, 27236) and fixation with a screw and side plate or intramedullary fixation (27244, 27245) for peritrochanteric fractures. Three time-to-surgery groups (<24 hours to surgical intervention, 24-48 hours, and >48 hours) were created and matched for surgery type, sex, age, and American Society of Anesthesiologists class. Time-to-surgery was then studied for its effect on the post-surgical outcomes using the adjusted regression modeling. A study population of 6036 hip fractures was created, and 2012 patients were assigned to each matched time-to-surgery group. The unadjusted models showed that the earlier surgical intervention groups (<24 hours and 24-48 hours) exhibited a lower overall complication rate (P = .034) compared with the group waiting for surgery >48 hours. The unadjusted mortality rates increased with delay to surgical intervention (P = .039). Time-to-surgery caused no effect on the return to the operating room rate (P = .554) nor readmission rate (P = .285). Compared with other time-to-surgeries, the time-to-surgery of >48 hours was associated with prolonged total hospital length of stay (10.9 days) (P < .001) and a longer surgery-to-discharge time (hazard ratio, 95% confidence interval: 0.74, 0.69-0.79) (P < .001). Adjusted analyses showed no time-to-surgery related difference in complications (P = .143) but presented an increase in the total length of stay (P < .001) and surgery-to-discharge time (P < .001). Timeliness of surgical intervention in a comorbidity-adjusted population of elderly hip fracture patients causes no effect on the overall complications, readmissions, nor 30-day mortality. However, time-to-surgery of >48 hours is associated with costly increase in the total length of stay, including an increased post-surgery-to-discharge time.
老年人髋部骨折后的发病率和死亡率受不可改变的合并症影响。手术时间是一个可改变的因素，可能对术后发病率产生影响。本研究调查了老年髋部骨折手术的结果和并发症与手术时间的关系。利用美国外科医师学会-国家外科质量改进计划2011年至2012年的数据，使用当前手术操作术语代码生成研究人群，这些代码用于经皮或开放治疗股骨颈骨折（27235、27236）以及使用螺钉和侧板固定或髓内固定（27244、27245）治疗转子周围骨折。创建了三个手术时间组（手术干预时间<24小时、24 - 48小时和>48小时），并根据手术类型、性别、年龄和美国麻醉医师协会分级进行匹配。然后使用调整后的回归模型研究手术时间对术后结果的影响。创建了一个包含6036例髋部骨折的研究人群，每个匹配的手术时间组分配2012例患者。未调整的模型显示，与等待手术>48小时的组相比，早期手术干预组（<24小时和24 - 48小时）的总体并发症发生率较低（P = 0.034）。未调整的死亡率随手术干预延迟而增加（P = 0.039）。手术时间对返回手术室率（P = 0.554）和再入院率（P = 0.285）没有影响。与其他手术时间相比，手术时间>48小时与总住院时间延长（10.9天）相关（P < 0.001）以及手术至出院时间延长（风险比，95%置信区间：0.74，0.69 - 0.79）（P < 0.001）。调整后的分析显示，手术时间与并发症之间无差异（P = 0.143），但总住院时间（P < 0.001）和手术至出院时间增加（P < 0.001）。在合并症调整后的老年髋部骨折患者人群中，手术干预的及时性对总体并发症、再入院率和30天死亡率没有影响。然而，手术时间>48小时与总住院时间的成本增加相关，包括手术后至出院时间增加。
