荷兰髋部骨折审核实施对老年髋部骨折患者死亡率、住院时间和手术时间的影响：一项多中心队列研究。

Effect of the Dutch Hip Fracture Audit implementation on mortality, length of hospital stay and time until surgery in elderly hip fracture patients; a multi-center cohort study.

机构信息

Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.

出版信息

Injury. 2020 Apr;51(4):1038-1044. doi: 10.1016/j.injury.2020.02.084. Epub 2020 Feb 19.

DOI:10.1016/j.injury.2020.02.084

PMID:32115205

Abstract

BACKGROUND

In 2040 the estimated number of people with a hip fracture in the Netherlands will be about 24,000. The medical care for this group of patients is complicated and challenging. Multidisciplinary approaches aim to improve clinical outcome. Quality indicators that gain insight in the treatment and outcome of hip fracture patients may help to optimize and monitor the standard of medical care. The Dutch Hip Fracture Audit (DHFA) is a new multidisciplinary quality indicator that is implemented in the Dutch hospitals in 2017.

AIM

The aim of this study was to determine the effect of the implementation of the DHFA on 30-day mortality, length of hospital stay and time until surgery in elderly with a hip fracture in the Netherlands.

METHODS

A multicenter retrospective comparative cohort study was conducted and data were extracted from the Dutch Nationwide Trauma Registration (LTR). Included were patients aged 60 years and older with a hip fracture (femoral neck and trochanteric) and admitted in one of the ten participating hospitals registered in 2015 and 2017. Data from 2015, before implementation of DHFA, were compared with data from 2017, when the DHFA was implemented. The primary outcome was 30-day mortality; secondary outcomes were length of hospital stay and time until surgery. Multivariable regression models were used to compare outcomes between groups.

RESULTS

3808 patients were included, 1839 in the 2015 cohort and 1969 in the 2017 cohort. 29% was male; mean age 82 years. The multilevel analysis showed a positive non-significant difference between groups on the primary outcome30-day mortality (OR adjusted 1.23, 95%CI 0.93 - 1.63). The secondary outcomes length of hospital stay (adjusted effect estimates -0.002, 95%CI -0.03 - 0.03) and time until surgery (adjusted effect estimates 0.292, 95%CI -2.68 - 3.26) showed no differences between groups.

CONCLUSIONS

Implementation of the DHFA quality indicator does have a positive non-significant trend on 30-day mortality, but showed no impact on length of hospital stay and time until surgery. More research on relevant quality indicators seems therefore mandatory.

摘要

背景

到 2040 年，荷兰髋部骨折患者人数预计将达到 24000 人左右。该人群的医疗护理复杂且具有挑战性。多学科方法旨在改善临床结果。了解髋部骨折患者治疗和结果的质量指标可以帮助优化和监测医疗护理的标准。荷兰髋部骨折审计（DHFA）是一种新的多学科质量指标，于 2017 年在荷兰医院实施。

目的

本研究旨在确定荷兰实施 DHFA 对 30 天死亡率、住院时间和髋部骨折患者手术时间的影响。

方法

进行了一项多中心回顾性比较队列研究，从荷兰全国创伤登记处（LTR）提取数据。纳入标准为年龄在 60 岁及以上的股骨颈和转子间髋部骨折患者，在 2015 年和 2017 年登记的 10 家参与医院之一入院。比较 2015 年（实施 DHFA 前）的数据与 2017 年（实施 DHFA 时）的数据。主要结局为 30 天死亡率；次要结局为住院时间和手术时间。使用多变量回归模型比较组间结局。

结果

共纳入 3808 例患者，其中 2015 年队列 1839 例，2017 年队列 1969 例。男性占 29%；平均年龄为 82 岁。多水平分析显示，两组 30 天死亡率的主要结局呈正非显著性差异（调整后 OR 1.23，95%CI 0.93-1.63）。次要结局住院时间（调整后效应估计值-0.002，95%CI-0.03-0.03）和手术时间（调整后效应估计值 0.292，95%CI-2.68-3.26）无差异。