From the Ocala Health Trauma, Ocala Regional Medical Center (D.A., H.L.), Ocala, Florida; Department of Surgery, University of South Florida (D.A., J. Armstrong), Tampa, Florida; University of Central Florida, College of Medicine (D.A.), Orlando, Florida; Division of Orthopedic Surgery, Mcleod Regional Medical Center (J. Anglen), Florence, South Carolina; Trauma Clinical Services Group, Hospital Corporation of America (M.Z., M.D., G.M., J.N.), Nashville, Tennessee; Department of Trauma, Sky Ridge Medical Center (P.O.), Lone Tree, Colorado; Department of Trauma, Kendall Regional Medical Center (M.M.), Miami, Florida; Department of Trauma, Riverside Community Hospital (D.P.), Riverside, California; Department of Trauma, Del Sol Medical Center (S.F.), El Paso, Texas; Department of Trauma, South Austin Medical Center (E.G.), Austin, Texas; Department of Trauma, TriStar Skyline Medical Center (R.N.), Nashville, Tennessee; and Department of Trauma, Medical City (M.C.), Plano, Texas.
J Trauma Acute Care Surg. 2021 Jan 1;90(1):113-121. doi: 10.1097/TA.0000000000002951.
Isolated hip fractures (IHFs) in the elderly are high-frequency, life-altering events. Definitive surgery ≤24 hours of admission is associated with improved outcomes. An IHF process management guideline (IHF-PMG) to expedite definitive surgery ≤24 hours was developed for a multihospital network. We report on its feasibility and subsequent patient outcomes.
This is a prospective multicenter cohort study, involving 85 levels 1, 2, 3, and 4 trauma centers. Patients with an IHF between 65 and 100 years old were studied. Four cohorts were examined: (1) hospitals that did not implement any PMG, (2) hospitals that used their own PMG, (3) hospitals that partially used the network IHF-PMG, and (4) hospitals that used the network's IHF-PMG. Multivariable logistic regression with reliability adjustment was used to calculate the expected value of observed to expected (O/E) mortality. Statistical significance was defined as p < 0.05.
Data on 24,457 IHF were prospectively collected. Following implementation of the IHF-PMG, overall IHF O/E mortality ratios decreased within the hospital network, from 1.13 in 2017 to 0.87 in 2018 and 0.86 in 2019. Hospitals that developed their own IHF-PMG or used the enterprise-wide IHF-PMG had the lowest inpatient O/E mortality at 0.59 and 0.65, respectively.
Goal-directed IHF-PMG for definitive surgery ≤24 hours was implemented across a large hospital network. The IHF-PMG was associated with lower inpatient mortality.
Therapeutic/ Care management, Level III.
老年人的孤立性髋部骨折（IHF）是高频、改变生活的事件。入院后 24 小时内进行确定性手术与改善结果相关。为一个多医院网络制定了一个加速 24 小时内确定性手术的孤立性髋部骨折过程管理指南（IHF-PMG）。我们报告其可行性和随后的患者结局。
这是一项前瞻性多中心队列研究，涉及 85 个 1、2、3 和 4 级创伤中心。研究了年龄在 65 至 100 岁之间的 IHF 患者。检查了四个队列：（1）未实施任何 PMG 的医院，（2）使用自己的 PMG 的医院，（3）部分使用网络 IHF-PMG 的医院，（4）使用网络 IHF-PMG 的医院。使用可靠性调整的多变量逻辑回归计算观察到的预期死亡率的预期值（O/E）。定义统计学意义为 p < 0.05。
前瞻性收集了 24457 例 IHF 数据。在实施 IHF-PMG 后，医院网络内总体 IHF O/E 死亡率从 2017 年的 1.13 下降到 2018 年的 0.87 和 2019 年的 0.86。制定自己的 IHF-PMG 或使用企业范围的 IHF-PMG 的医院的住院患者 O/E 死亡率最低，分别为 0.59 和 0.65。
针对 24 小时内确定性手术的目标导向性 IHF-PMG 在大型医院网络中实施。IHF-PMG 与较低的住院死亡率相关。
治疗/护理管理，III 级。
