Trauma and Orthopaedics Department, Croydon University Hospital, Croydon, London, UK.
Radiology Department, St. George's Hospital, London, UK.
Hip Int. 2022 Mar;32(2):276-280. doi: 10.1177/1120700020972025. Epub 2020 Nov 4.
Hip fractures are an important cause of morbidity and mortality. Early surgery has been shown to reduce mortality rates and surgical complications. The American Society of Anesthesiologists (ASA) grade is a widely used tool to assess preoperative health of patients. This study aims to assess is whether delay in surgical time has a greater impact on the mortality rates for high risk patients.
Retrospective study using the National Hip Fracture Database (NHFD) of 4883 neck of femur fracture patients. Time of surgery, ASA grade, reason for delay and mortality at 120 days was analysed, using statistical analysis software.
There was a significant increase in mortality ( < 0.001) with increasing ASA grade. Surgical delays of more than 36 hours increased mortality by 2.9%. The impact of delaying surgery became more pronounced as the ASA grade increased. ASA 3 and above had an optimum time to surgery of between 12 and 24 hours giving the statistically significant lowest mortality rate ( = 0.004).
Surgical delay beyond the 36-hour target for surgery has a greater impact on mortality for patients with higher ASA grades. The effect is most profound in the high-risk ASA grade 5 patients with delayed patients showing a 37.5% increase in mortality in this group. This would imply that by prioritising this higher risk group and operating on it within a specific time frame there would be a subsequent fall in mortality associated with neck of femur fractures.
髋部骨折是发病率和死亡率的重要原因。早期手术已被证明可以降低死亡率和手术并发症。美国麻醉师协会（ASA）分级是评估患者术前健康状况的常用工具。本研究旨在评估手术时间延迟是否对高危患者的死亡率有更大的影响。
使用国家髋部骨折数据库（NHFD）对 4883 例股骨颈骨折患者进行回顾性研究。使用统计分析软件分析手术时间、ASA 分级、延迟原因和 120 天死亡率。
随着 ASA 分级的增加，死亡率显著增加（<0.001）。手术延迟超过 36 小时会使死亡率增加 2.9%。随着 ASA 分级的增加，手术延迟的影响变得更加明显。ASA 3 级及以上患者的最佳手术时间为 12 至 24 小时，死亡率最低（=0.004）。
手术时间超过 36 小时的延迟对 ASA 分级较高的患者的死亡率有更大的影响。在高风险的 ASA 5 级患者中，这种影响最为明显，延迟患者的死亡率增加了 37.5%。这意味着通过优先考虑这个高风险群体，并在特定的时间框架内对其进行手术，与股骨颈骨折相关的死亡率将会随之下降。
