Department of Orthopedic and Emergency Surgery, Alfried Krupp Hospital, Essen, Germany.
Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany.
Injury. 2021 Mar;52(3):554-561. doi: 10.1016/j.injury.2020.09.007. Epub 2020 Sep 15.
Time-to-surgery in geriatric hip fractures remains of interest. The majority of the literature reports a significantly decreased mortality rate after early surgery. Nevertheless, there are some studies presenting no effect of time-to-surgery on mortality. The body of literature addressing the effect of an orthogeriatric co-management is growing. Here we investigate the effect of time-to-surgery on in-house mortality in a group of patients treated under the best possible conditions in certified orthogeriatric treatment units.
We conducted a retrospective cohort registry analysis from prospectively collected data of the AltersTraumaRegister DGU®. Data were analyzed univariably, and the association of early surgery with in-house mortality was assessed with multivariable logistic regression while controlling for specified patient characteristics. Additionally, propensity score matching for time-to-surgery was applied to examine its effect on the in-house mortality rate.
A total of 15,099 patients met the inclusion criteria. The median age was 85 years (IQR 80-89), and 72.1% were female. The overall in-house mortality rate was 5.5%. Most (71.2%) of the patients were treated within 24 h, and 91.6% within 48 h. Neither the multivariable logistic regression model nor the propensity score matching indicated that early surgery was associated with a decreased mortality rate. The most important indicators for mortality were ASA ≥ 3 [Odds ratio (OR) 3.4, 95% confidence interval (CI) 2.35-5.11], fracture event during inpatient stay (OR 2.6, 95% CI 1.48-4.3), ISAR ≥ 2 (OR 1.88, 95% CI 1.33-2.76), and male gender (OR 1.71, 95% CI 1.39-2.09).
Our results suggest that for those patients, who were treated in an orthogeriatric co-management under the best possible conditions, there are no significant differences regarding in-house mortality rate between the time-to-surgery intervals of 24 and 48 h or slightly above. This and the comparatively small number of patients who underwent surgery after 24 h show that an extension of the pre-surgery interval, justified by an orthogeriatric treatment team, will not be detrimental to the affected patients.
老年人髋部骨折的手术时间仍然是一个值得关注的问题。大多数文献报道，早期手术可显著降低死亡率。然而，也有一些研究表明手术时间对死亡率没有影响。目前，越来越多的文献研究了骨科老年病学联合管理对死亡率的影响。在此，我们研究了在经过认证的骨科老年病学治疗单元中，接受最佳治疗的一组患者的手术时间对院内死亡率的影响。
我们对 AlterstraumaRegister DGU®前瞻性收集的数据进行了回顾性队列分析。对数据进行单变量分析，同时控制指定的患者特征，使用多变量逻辑回归评估早期手术与院内死亡率的相关性。此外，还进行了手术时间的倾向评分匹配，以检验其对院内死亡率的影响。
共有 15099 名患者符合纳入标准。患者的中位年龄为 85 岁（IQR 80-89），72.1%为女性。总体院内死亡率为 5.5%。大多数（71.2%）患者在 24 小时内接受治疗，91.6%在 48 小时内接受治疗。多变量逻辑回归模型和倾向评分匹配均未表明早期手术与死亡率降低相关。死亡率的最重要指标是 ASA≥3（优势比[OR]3.4，95%置信区间[CI]2.35-5.11）、住院期间骨折事件（OR 2.6，95%CI 1.48-4.3）、ISAR≥2（OR 1.88，95%CI 1.33-2.76）和男性（OR 1.71，95%CI 1.39-2.09）。
我们的研究结果表明，对于那些在骨科老年病学联合管理下接受最佳治疗的患者，在 24 小时和 48 小时或稍长的手术时间间隔内，其院内死亡率没有显著差异。这一结果以及只有相对较少的患者在 24 小时后接受手术，表明在经过骨科老年病学治疗团队评估后，延长术前间隔时间不会对患者造成伤害。
