Department of Orthopaedic Surgery, Tan Tock Seng Hospital Singapore, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.
Department of Orthopaedic Surgery, Woodlands Health Campus, Singapore, Singapore.
Arch Orthop Trauma Surg. 2021 Jul;141(7):1183-1187. doi: 10.1007/s00402-020-03585-2. Epub 2020 Aug 26.
The recent focus on early surgery for hip fractures to reduce complications and improve morbidity, has led some resource-constrained institutions to perform after hours surgery in a bid to meet these timelines. However, there are concerns about the potential increase in complications and poorer outcomes in after hours surgery. This study aims to evaluate the safety of after hours hip fracture surgery and its related complications.
This is a retrospective review of hip fracture patients admitted over a 2-year period to a tertiary centre with an established orthogeriatric co-managed hip fracture care pathway. Patients were divided into two groups based on their operating start time: (1) office hours surgery was defined as surgery conducted between 8 am to 5 pm on weekdays and 8 am to 12 noon on Saturdays; and (2) after hours surgery was defined as surgery conducted between 5 pm to 8 am on weekdays, and between Saturday 12 noon to Monday 8 am, as well as those that were conducted on public holidays. Demographic data, comorbidities, fracture details, operative details and outcome measures (complications, mortality and functional scores) were collated.
A total of 903 patients were surgically treated for per- and intertrochanteric or femoral neck fractures. 76.7% (n = 693) of the patients underwent operation during office hours while 23.3% (n = 210) of the patients underwent after hours operation. 12.4% (n = 26) of the after hours group underwent surgery within 24 h of admission, compared with 6.8% (n = 47) in the office hours group (p = 0.009). We did not find any significant difference between the two groups in terms of complications, mortality and functional outcomes (p > 0.05).
In conclusion, our study did not show that after hours surgery increases complication rates in hip fracture surgery and had equivalent functional outcomes.
最近，人们关注髋部骨折的早期手术以减少并发症并提高发病率，这导致一些资源有限的机构为了满足这些时间限制而在非工作时间进行手术。然而，人们对非工作时间手术潜在并发症增加和预后较差的情况存在担忧。本研究旨在评估非工作时间髋部骨折手术的安全性及其相关并发症。
这是对一家三级中心在 2 年内收治的采用既定矫形科与老年科联合管理髋部骨折治疗途径的髋部骨折患者进行的回顾性研究。根据手术开始时间，患者被分为两组：（1）正常工作时间手术定义为工作日 8:00 至 17:00 以及周六 8:00 至 12:00 进行的手术；（2）非工作时间手术定义为工作日 17:00 至 8:00、周六 12:00 至周一 8:00 以及公共假日进行的手术。收集了人口统计学数据、合并症、骨折细节、手术细节和结果测量（并发症、死亡率和功能评分）。
共有 903 例患者接受了股骨颈或粗隆间骨折的手术治疗。76.7%（n=693）的患者在正常工作时间进行手术，23.3%（n=210）的患者在非工作时间进行手术。非工作时间组中有 12.4%（n=26）的患者在入院后 24 小时内进行手术，而正常工作时间组中这一比例为 6.8%（n=47）（p=0.009）。两组在并发症、死亡率和功能结果方面无显著差异（p>0.05）。
总之，本研究并未表明非工作时间手术会增加髋部骨折手术的并发症发生率，并且具有等效的功能结果。
