Seong Yoon Jae, Shin Won Chul, Moon Nam Hoon, Suh Kuen Tak
Department of Orthopaedic Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea.
Department of Orthopaedic Surgery, Pusan National University Hospital, Busan, Korea.
Hip Pelvis. 2020 Mar;32(1):11-16. doi: 10.5371/hp.2020.32.1.11. Epub 2020 Feb 26.
The incidence of hip fractures is rapidly increasing with an aging population and is now one of the most important health concerns worldwide due to a high mortality rate. The effect of delayed surgery on postoperative outcomes has been widely discussed. Although various treatment guidelines for hip fractures in the elderly exist, most institutions recommend that operations are conducted as soon as possible to help achieve the most favorable outcomes. While opinions differ on the relationship between delayed surgery and postoperative mortality, a strong association between earlier surgery and improvement in postoperative outcomes (e.g., length of hospital stay, bedsore occurrence, return to an independent lifestyle), has been reported. Taken together, performing operations for hip fractures in the elderly within 48 hours of admission appears to be best practice. Importantly, however, existing evidence is based primarily on observational studies which are susceptible to inherent bias. Here, we share the results of a literature search to summarize data that helps inform the most appropriate surgical timing for hip fractures in the elderly and the effects of delayed surgery on postoperative outcome. In addition, we expect to be able to provide a more accurate basis for these correlations through a large-scale randomized controlled trial in the future and to present data supporting recommendations for appropriate surgical timing.
随着人口老龄化，髋部骨折的发病率正在迅速上升，由于死亡率高，髋部骨折现已成为全球最重要的健康问题之一。延迟手术对术后结果的影响已得到广泛讨论。尽管存在各种针对老年人髋部骨折的治疗指南，但大多数机构建议尽快进行手术，以帮助实现最有利的结果。虽然对于延迟手术与术后死亡率之间的关系存在不同意见，但已有报道称早期手术与术后结果的改善（如住院时间、褥疮发生、恢复独立生活方式）之间存在密切关联。综上所述，在入院48小时内为老年人进行髋部骨折手术似乎是最佳做法。然而，重要的是，现有证据主要基于观察性研究，这些研究容易受到固有偏差的影响。在此，我们分享文献检索结果，以总结有助于为老年人髋部骨折确定最合适手术时机以及延迟手术对术后结果影响的数据。此外，我们期望未来能够通过大规模随机对照试验为这些相关性提供更准确的依据，并提供支持适当手术时机建议的数据。
