Ogawa Takahisa, Aoki Takuya, Shirasawa Shinichi
Department of Orthopaedics, Suwa Central Hospital, Japan; Department of Orthopaedics, Tokyo Medical and Dental University, Japan.
Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Japan.
J Orthop Sci. 2019 May;24(3):469-473. doi: 10.1016/j.jos.2018.11.001. Epub 2018 Nov 28.
Hip fracture constitutes a high-mortality injury in elderly patients. In addition, caregiver burden is also a relevant issue, as patients after hip fracture surgery lose ambulation and require support in the perioperative period and after discharge. Early surgery is recommended to improve mortality. However the positive effect of early surgery on the short-term postoperative ambulatory function is unknown. The objective of this study was to determine whether a shorter waiting time for hip fracture surgery improves short-term postoperative mobility in elderly patients. We used the cumulated ambulation score (CAS), a feasible function scoring system using low-demand activities, to measure short-term postoperative mobility.
In this retrospective, observational study of 175 hip fracture patients at a single hospital, the patients were divided based on the waiting period for surgery (within 24 hours of arrival, early group; after 24 hours of arrival, delayed group). The primary outcome was postoperative mobility, assessed using the CAS. Multivariable linear regression analysis with adjustment for covariates, age, sex, mobility before injury, comorbidity, presence of dementia and type of fracture. As a subgroup analysis, cognitive function and the interaction between the surgical waiting time and the presence of dementia were considered.
The early group had a significantly better CAS (adjusted beta = 1.36; 95% confidence interval [95% CI]: 0.24-2.48, p = 0.02) than the delayed group. Significant CAS improvement was observed among cognitively intact patients (adjusted beta = 2.66; 95% CI: 0.62-4.69, p = 0.01), but not among those with dementia (adjusted beta = 0.43; 95% CI: -0.93 to 1.79, p = 0.53). However, the interaction between the surgical waiting time and the presence of dementia in the entire population did not reach statistical significance (p for interaction = 0.15).
Hip fracture surgery within 24 hours could improve the recovery of postoperative ambulatory function faster. The postoperative caregiver burden would be reduced by early surgery.
髋部骨折在老年患者中是一种高致死性损伤。此外，照顾者负担也是一个相关问题，因为髋部骨折手术后的患者会失去行走能力，在围手术期及出院后都需要支持。建议早期手术以降低死亡率。然而，早期手术对术后短期行走功能的积极影响尚不清楚。本研究的目的是确定缩短髋部骨折手术等待时间是否能改善老年患者术后短期活动能力。我们使用累积行走评分（CAS），这是一种利用低需求活动的可行功能评分系统，来衡量术后短期活动能力。
在一家医院对175例髋部骨折患者进行的这项回顾性观察研究中，根据手术等待期对患者进行分组（到达后24小时内，早期组；到达后24小时后，延迟组）。主要结局是术后活动能力，采用CAS进行评估。进行多变量线性回归分析，并对协变量、年龄、性别、受伤前活动能力、合并症、痴呆症的存在情况和骨折类型进行校正。作为亚组分析，考虑了认知功能以及手术等待时间与痴呆症存在情况之间的相互作用。
早期组的CAS明显优于延迟组（校正β = 1.36；95%置信区间[95%CI]：0.24 - 2.48，p = 0.02）。在认知功能正常的患者中观察到CAS有显著改善（校正β = 2.66；95%CI：0.62 - 4.69，p = 0.01），但在患有痴呆症的患者中未观察到（校正β = 0.43；95%CI： - 0.93至1.79，p = 0.53）。然而，在整个人口中，手术等待时间与痴呆症存在情况之间的相互作用未达到统计学意义（交互作用p = 0.15）。
24小时内进行髋部骨折手术可更快改善术后行走功能的恢复。早期手术可减轻术后照顾者的负担。
