Shigemoto Kenji, Sawaguchi Takeshi, Goshima Kenichi, Iwai Shintarou, Nakanishi Akira, Ueoka Ken
Department of Orthopedic Surgery and Joint Reconstructive Surgery, Toyama Municipal Hospital, Toyama, Japan.
Department of Orthopedic Surgery and Joint Reconstructive Surgery, Toyama Municipal Hospital, Toyama, Japan.
J Orthop Sci. 2019 Mar;24(2):280-285. doi: 10.1016/j.jos.2018.09.012. Epub 2018 Oct 6.
This study aimed to report results of the multidisciplinary treatment approach for geriatric hip fractures and evaluate its effectiveness compared with conventional treatment. Patients aged 65 years and older who presented with a hip fracture at our hospital on or after 2014 were treated according to a multidisciplinary approach.
Two groups of patients with hip fracture were compared. Group I (n = 364) was treated according to the new multidisciplinary approach in 2014-2016, and Group II (n = 105) which received conventional treatment in 2012. Time to surgery, length of hospital stay, postoperative complications, osteoporosis treatment, functional recovery, in-hospital mortality, 90-day mortality, and 1-year mortality were evaluated. The medical costs of multidisciplinary treatment were compared with those in other hospitals every year.
There were no significant differences in the time to surgery between Group I and Group II, but each was considerably shorter than the average time in other Japanese hospitals. The length of hospital stay was longer in Group I. The overall postoperative complication rate was lower in Group I, but there was no significant difference for each individual complication. The rate of anti-osteoporosis pharmacotherapy administration at the time of discharge was significantly higher in Group I. Moreover, the proportion of patients who recovered to their pre-injury functional level was significantly higher in Group I. The mortality rates did not significantly differ year on year. The total hospitalization medical cost per patient for the multidisciplinary treatment was lower than other hospital costs every year.
Multidisciplinary treatment produced no significant improvement in time to surgery, length of hospital stay, or postoperative complications. However, the use of the multidisciplinary treatment approach led to a significant increase in osteoporosis treatment rate and better functional recovery. Furthermore, the total medical costs for multidisciplinary treatment were lower than the acute care hospital costs.
本研究旨在报告老年髋部骨折多学科治疗方法的结果，并评估其与传统治疗方法相比的有效性。2014年及以后在我院出现髋部骨折的65岁及以上患者采用多学科方法进行治疗。
比较两组髋部骨折患者。第一组（n = 364）在2014 - 2016年采用新的多学科方法进行治疗，第二组（n = 105）在2012年接受传统治疗。评估手术时间、住院时间、术后并发症、骨质疏松症治疗、功能恢复、院内死亡率、90天死亡率和1年死亡率。每年将多学科治疗的医疗费用与其他医院的费用进行比较。
第一组和第二组的手术时间没有显著差异，但均明显短于日本其他医院的平均时间。第一组的住院时间更长。第一组的总体术后并发症发生率较低，但每种个体并发症无显著差异。第一组出院时抗骨质疏松药物治疗的给药率显著更高。此外，第一组恢复到受伤前功能水平的患者比例显著更高。死亡率逐年没有显著差异。多学科治疗每位患者的住院总医疗费用每年均低于其他医院费用。
多学科治疗在手术时间、住院时间或术后并发症方面没有显著改善。然而，采用多学科治疗方法导致骨质疏松症治疗率显著提高和功能恢复更好。此外，多学科治疗的总医疗费用低于急症医院费用。
