老年髋部骨折患者的治疗一致性：老年创伤中心综合骨科-老年科治疗模式实施 10 年后的结果是否一致？

The consistency of care for older patients with a hip fracture: are the results of the integrated orthogeriatric treatment model of the Centre of Geriatric Traumatology consistent 10 years after implementation?

机构信息

Department of Trauma Surgery, Ziekenhuisgroep Twente, Zilvermeeuw 1, 7609 PP, Almelo, The Netherlands.

Telemedicine Group, Biomedical Signals and Systems, Faculty of Electrical Engineering, University of Twente, Drienerlolaan 5, 7522 NB, Enschede, The Netherlands.

出版信息

Arch Osteoporos. 2018 Nov 19;13(1):131. doi: 10.1007/s11657-018-0550-5.

DOI:10.1007/s11657-018-0550-5

PMID:30456430

Abstract

UNLABELLED

In the past 10 years after implementation, the orthogeriatric treatment model led in general to consistent outcomes for 1555 older adults in terms of most of the complications and mortality. Surgery was more often delayed to 24-48 h after arrival at the hospital, while the length of hospital stay shortened.

INTRODUCTION

Since 1 April 2008, patients aged ≥ 70 years presenting themselves with a hip fracture at Ziekenhuisgroep Twente (ZGT) have been treated according to the orthogeriatric treatment model. The aim of this study was to investigate if outcomes of the orthogeriatric treatment model are consistent over the first 10 years after implementation.

METHODS

Between 1 April 2008 and 31 December 2016, patients aged ≥ 70 years who were surgically treated at ZGT for a hip fracture were included and divided into three periods equally distributed in time. Patient characteristics, in-hospital logistics, complications, and mortality data were compared between the three periods.

RESULTS

A total of 1555 patients were included. There was a shift in the surgical treatment for the fractured neck of femur from dynamic hip screw/cannulated screws to hemiarthroplasty (p < 0.001). Surgery within 24 h after arrival to the hospital decreased (p < 0.001), while surgery within 48 h stayed the same (p = 0.085). Length of hospital stay significantly decreased over time (p < 0.001). Complication rates were consistent except for the number of postoperative anemia, delirium, and urinary tract infections. Mortality rates did not change over the years.

CONCLUSIONS

The orthogeriatric treatment model leads in general to consistent outcomes concerning mortality and most of the complications, except for postoperative anemia, delirium, and urinary tract infections. Inconsistent complication rates were influenced by altered diagnosis and treatment protocols. Length of hospital stay reduced, while time to surgery was more often delayed to 24-48 h. Monitoring clinical outcomes of the orthogeriatric treatment model over time is recommended in order to optimize and maintain the quality of care for this frail patient population.

摘要

目的

自 2008 年 4 月 1 日起，在特温特医疗集团（ZGT）就诊的年龄≥70 岁的髋部骨折患者开始接受矫形骨科治疗模式治疗。本研究旨在探讨该模式实施 10 年后的治疗效果是否一致。

方法

2008 年 4 月 1 日至 2016 年 12 月 31 日，ZGT 对年龄≥70 岁的髋部骨折患者进行手术治疗，患者分为 3 个时间段，每个时间段时间相等。比较了 3 个时间段的患者特征、住院流程、并发症和死亡率数据。

结果

共纳入 1555 例患者。股骨颈骨折的手术治疗从动力髋螺钉/空心螺钉向半髋关节置换转变（p<0.001）。术后 24 小时内手术量减少（p<0.001），而术后 48 小时内手术量不变（p=0.085）。住院时间明显缩短（p<0.001）。除术后贫血、谵妄和尿路感染的发生率外，并发症发生率保持一致。死亡率多年来没有变化。