Öztürk Buket, Johnsen Søren P, Röck Niels Dieter, Pedersen Lars, Pedersen Alma B
Department of Clinical Epidemiology, Aarhus University Hospital, Denmark.
Department of Clinical Epidemiology, Aarhus University Hospital, Denmark; Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Denmark.
Injury. 2019 Feb;50(2):424-431. doi: 10.1016/j.injury.2018.12.032. Epub 2018 Dec 29.
To examine the association between surgery delay and mortality in hip fracture patients with and without known comorbidity.
We identified all patients with a first time hip fracture diagnose operated between January 1, 2010 and December 31, 2015 (n = 36,552). As a measure of comorbidity we used Charlson Comorbidity Index stratified in categories: none (no registered comorbidities prior fracture), medium (1-2 points) and high (≥3 points).
No association between surgery delay, regardless of the threshold, and 30-days mortality was observed among patients with high level of comorbidity. Surgery delay of >24h vs. ≤24 h was associated with higher 0-30-days mortality in patients with medium level of comorbidity (adjusted HR: 1.12 (95% CI: 1.01 ; 1.24)). In addition, surgery delay was associated with up to 45% increased mortality in patients with none comorbidity prior surgery, although the confidence intervals were wide. Furthermore, surgery delay of >24 h (vs. <24 h) and >48 h (vs. ≤48 h) was associated with higher 31-90-days mortality among all patients (adjusted HR: 1.19 (95% CI: 1.10 ; 1.29) and 1.35 (95% CI: 1.16 ; 1.56), respectively), but in particular among patients with none (adjusted HR: 1.26 (95% CI: 1.08 ; 1.47) and 1.65 (95% CI: 1.26 ; 2.17), respectively) and medium (adjusted HR: 1.21 (95% CI: 1.07 ; 1.36) and 1.25 (95% CI: 1.00 ; 1.57), respectively) level of comorbidity at the time of surgery.
There was an association between surgery delay and 30-days mortality in hip fracture surgery patients with none and medium level of comorbidity, whereas no such association was observed among hip fracture patients with a high comorbidity level. Surgery delay was associated with one year increased risk of dying in both patients with and without comorbidity prior surgery.
研究有或无已知合并症的髋部骨折患者手术延迟与死亡率之间的关联。
我们确定了2010年1月1日至2015年12月31日期间首次诊断为髋部骨折并接受手术的所有患者（n = 36,552）。作为合并症的衡量指标，我们使用了Charlson合并症指数，分为以下几类：无（骨折前无合并症记录）、中度（1 - 2分）和高度（≥3分）。
在合并症程度高的患者中，未观察到手术延迟（无论阈值如何）与30天死亡率之间的关联。在合并症程度为中度的患者中，手术延迟>24小时与≤24小时相比，0 - 30天死亡率更高（调整后风险比：1.12（95%置信区间：1.01；1.24））。此外，尽管置信区间较宽，但在手术前无合并症的患者中，手术延迟与死亡率增加高达45%相关。此外，手术延迟>24小时（与<24小时相比）和>48小时（与≤48小时相比）与所有患者31 - 90天死亡率更高相关（调整后风险比分别为：1.19（95%置信区间：1.10；1.29）和1.35（95%置信区间：1.16；1.56）），但在手术时无合并症（调整后风险比分别为：1.26（95%置信区间：1.08；1.47）和1.65（95%置信区间：1.26；2.17））和中度合并症（调整后风险比分别为：1.21（95%置信区间：1.07；1.36）和1.25（95%置信区间：1.00；1.57））的患者中尤为明显。
在无合并症和中度合并症的髋部骨折手术患者中，手术延迟与30天死亡率之间存在关联，而在合并症程度高的髋部骨折患者中未观察到这种关联。手术延迟与手术前有或无合并症的患者死亡风险增加一年相关。
