Yaacobi Eyal, Marom Omer, Gutman Nadav, Zabarqa Shatha, Brin Yaron, Ohana Nissim
Orthopaedic Department, Meir Medical Center, Kfar Saba, Affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
Hadassah Medical School, The Hebrew University, Jerusalem, Israel.
Hip Int. 2022 Mar;32(2):271-275. doi: 10.1177/1120700020945942. Epub 2020 Jul 27.
Hip fractures are prevalent in the elderly population and present serious health, social and economic problems, with an impact on morbidity and mortality. Today, it is common practice to surgically repair these fractures as early as possible, preferably within 48 hours of hospital admission. However, there is conflicting evidence in the literature about the effect of the timing of surgery on postoperative mortality.
To assess the association between surgery delay and other demographic and clinical variables with an increased mortality rate after surgical treatment of hip fractures in the elderly.
A retrospective study was conducted on patients aged ⩾65 years with a primary diagnosis of hip fracture. All patients underwent surgery in our Medical Center from 2015 to 2017. A multivariate model of logistic regression, Cox regression model and Kaplan-Meier survival analysis were used to evaluate the relationship between various variables and mortality rates at 3- and 12-month follow-ups.
A total of 877 patients were included, 30% were men and 70% women; the mean age was 83.3 years. Multivariate analysis showed that mortality was significantly higher among patients who underwent late surgery, after adjusting for gender, age, co-morbidity, age of surgeon, duration of surgery and duration of hospitalisation (0.030). Surgical delay was significantly associated with higher mortality rates both at 3 month (0.041) and at 12 months after surgery (0.013). The presence of ischemic heart disease, congestive heart failure, paroxysmal atrial fibrillation and chronic renal failure, as well as male gender and older age, were also significantly associated with higher early and late mortality.
In elderly patients, hip fracture surgery should be performed within 48 hours of admission. Male and older patients, as well as patients with the aforementioned co-morbidities, are at higher risk of mortality at 3 and 12 months after surgery.
髋部骨折在老年人群中很常见，会带来严重的健康、社会和经济问题，对发病率和死亡率产生影响。如今，尽早对这些骨折进行手术修复是常见做法，最好在入院后48小时内进行。然而，关于手术时机对术后死亡率的影响，文献中的证据相互矛盾。
评估老年髋部骨折手术治疗后，手术延迟与其他人口统计学和临床变量与死亡率增加之间的关联。
对年龄≥65岁、初步诊断为髋部骨折的患者进行回顾性研究。2015年至2017年期间，所有患者均在我们的医疗中心接受了手术。采用逻辑回归多变量模型、Cox回归模型和Kaplan-Meier生存分析来评估各种变量与3个月和12个月随访时死亡率之间的关系。
共纳入877例患者，30%为男性，70%为女性；平均年龄为83.3岁。多变量分析显示，在调整性别、年龄、合并症、外科医生年龄、手术时间和住院时间后，接受延迟手术的患者死亡率显著更高（0.030）。手术延迟与术后3个月（0.041）和12个月（0.013）的较高死亡率显著相关。缺血性心脏病、充血性心力衰竭、阵发性心房颤动和慢性肾衰竭的存在，以及男性性别和年龄较大，也与较高的早期和晚期死亡率显著相关。
老年患者的髋部骨折手术应在入院后48小时内进行。男性和老年患者，以及患有上述合并症的患者，在术后3个月和12个月的死亡风险较高。
