Scott Bryan L, King Connor A, Lee Cody S, Lee Michael J, Su Edwin P, Landy David C
Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago, Chicago, IL, USA.
Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA.
Arthroplast Today. 2020 Aug 5;6(3):628-633.e0. doi: 10.1016/j.artd.2020.06.008. eCollection 2020 Sep.
Despite an increasing incidence and associated morbidity, the optimal timing for the surgical management of periprosthetic hip fractures remains unknown. This study sought to explore whether time to surgery was associated with medical or surgical complications.
A retrospective review of Medicare data from 2010 to 2014 was performed using PearlDiver. All patients with a periprosthetic hip fracture greater than 90 days from surgery and undergoing open reduction internal fixation (ORIF) or revision total hip arthroplasty (RTHA) were included. Time to surgery was measured from diagnosis and dichotomized at 48 hours.
Of 342 patients undergoing ORIF, 269 (79%) had surgery within 48 hours. Of 255 patients undergoing RTHA, 142 (56%) had surgery within 48 hours. For ORIF, surgery more than 48 hours after diagnosis was associated with an increased rate of 30-day deep vein thrombosis or pulmonary embolism (15% vs 7%, = .03), which remained after adjustment (odds ratio [OR]: 2.71, 95% confidence interval [CI]: 1.11-6.45). A similar association was seen for RTHA (12% vs 6%, = .09 and OR: 2.61, 95% CI 1.01-7.24). For RTHA, surgery more than 48 hours after diagnosis was associated with an increased rate of 90-day periprosthetic joint infection (12% vs 4%, = .007), which remained after adjustment (OR: 3.86, 95% CI: 1.36-12.72). A similar but not significant association was seen for ORIF (7% vs 3%, = .18 and OR: 2.65, 95% CI: 0.73-8.91).
Among Medicare patients with a periprosthetic hip fracture, time to surgery greater than 48 hours was associated with increased medical and surgical complications.
尽管人工髋关节周围骨折的发病率不断上升且相关发病率也在增加，但人工髋关节周围骨折手术治疗的最佳时机仍不清楚。本研究旨在探讨手术时机是否与医疗或手术并发症相关。
使用PearlDiver对2010年至2014年医疗保险数据进行回顾性分析。纳入所有人工髋关节周围骨折且距离上次手术超过90天、接受切开复位内固定术（ORIF）或翻修全髋关节置换术（RTHA）的患者。手术时机从诊断开始计算，并在48小时进行二分法划分。
在342例行ORIF的患者中，269例（79%）在48小时内接受了手术。在255例行RTHA的患者中，142例（56%）在48小时内接受了手术。对于ORIF，诊断后超过48小时进行手术与30天深静脉血栓形成或肺栓塞发生率增加相关（15%对7%，P = 0.03），调整后仍然存在（比值比[OR]：2.71，95%置信区间[CI]：1.11 - 6.45）。RTHA也观察到类似的关联（12%对6%，P = 0.09，OR：2.61，95% CI 1.01 - 7.24）。对于RTHA，诊断后超过48小时进行手术与90天人工关节感染率增加相关（12%对4%，P = 0.007），调整后仍然存在（OR：3.86，95% CI：1.36 - 12.72）。ORIF也观察到类似但不显著的关联（7%对3%，P = 0.18，OR：2.65，95% CI：0.73 - 8.91）。
在患有人工髋关节周围骨折的医疗保险患者中，手术时机超过48小时与医疗和手术并发症增加相关。
