Department of Surgery-Traumatology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
PLoS One. 2019 Jan 7;14(1):e0210239. doi: 10.1371/journal.pone.0210239. eCollection 2019.
Surgery for hip fractures is frequently followed by complications that hinder the rehabilitation. Only part of the complications are surgery-related, however these, including reoperation may have the highest impact. Operative protocols are designed to treat all patients equally, according to evidence based guidelines. Aim of this study was to investigate the association between strict adherence to an operative protocol and postoperative complications, especially reoperations.
A retrospective analyses of a prospective cohort. The cohort included all patients aged ≥60 treated for a hip fracture at University Medical Center Groningen between July 2009 and June 2013. The files of the patients were searched for complications, including reoperations. To evaluate adherence to the operative protocol all X-rays were retrospectively reviewed and the fracture type was reclassified. This retrospective fracture classification was compared with the treatment method used. Logistic regression analyses were used to assess whether patients that were not treated strictly according to the operative protocol have higher odds of developing a complication or of undergoing a reoperation.
The study population consisted of 479 patients with a mean age of 78.4 (SD 9.5) years. Reoperation was performed in 11% of the patients during the follow-up period. The operative protocol was not followed strictly in 12% of the patients. When the operative protocol was not followed, the odds of having a reoperation was 2.41 times higher (p = 0.02). The overall complication rate was 75% and did not differ in both groups.
Strict adherence to an evidence-based operative protocol is of major importance toward preventing implant-related problems and reoperations.
髋部骨折手术后常出现并发症，这会阻碍康复。然而，只有一部分并发症与手术相关，包括再次手术，这些并发症的影响可能最大。手术方案旨在根据循证指南平等地治疗所有患者。本研究旨在调查严格遵守手术方案与术后并发症（尤其是再次手术）之间的关联。
这是一项前瞻性队列的回顾性分析。该队列包括 2009 年 7 月至 2013 年 6 月在格罗宁根大学医学中心治疗的所有年龄≥60 岁的髋部骨折患者。搜索患者的病历以了解并发症，包括再次手术。为了评估对手术方案的遵守情况，所有 X 射线均进行了回顾性审查，并对骨折类型进行了重新分类。将这种回顾性骨折分类与所使用的治疗方法进行比较。使用逻辑回归分析评估未严格按照手术方案治疗的患者发生并发症或再次手术的可能性是否更高。
该研究人群由 479 名平均年龄为 78.4（9.5）岁的患者组成。在随访期间，有 11%的患者接受了再次手术。在 12%的患者中，手术方案未得到严格遵守。当未严格遵守手术方案时，再次手术的可能性要高 2.41 倍（p = 0.02）。总体并发症发生率为 75%，两组之间无差异。
严格遵守基于证据的手术方案对于预防植入物相关问题和再次手术至关重要。
