Christchurch Hospital, Canterbury District Health Board, Christchurch.
lanning and Funding, Canterbury District Health Board, Christchurch.
N Z Med J. 2020 Dec 4;133(1526):31-44.
For older patients with hip fracture, we explored patient characteristics, outcomes and osteoporosis treatments for those admitted to rehabilitation compared to those discharged directly from hospital, using data set analysis.
Retrospective cohort study including all consecutive patients (65 years and over) admitted to Christchurch Hospital over one year. Outcomes were compared for patients in four groups: 1) aged residential care (ARC) residents and 2) not ARC residents discharge from acute orthopaedics, and those discharged from 3) orthogeriatric or 4) general geriatric rehabilitation. Clinical data was extracted from hospital data warehouse using signals from noise.
Over 12 months, 415 patients were admitted with hip fracture. Over half (n=282) were transferred for inpatient rehabilitation. Thirty-day mortality was 10%. Mortality at 180 days was 7% in orthogeriatric rehabilitation group and 8% in general rehabilitation group. Length of stay was shorter in orthogeriatric compared with general rehabilitation (median 12.9 vs 20.4 days). Osteoporosis treatment was addressed in 88% of patients in the orthogeriatric group compared with 62% in general rehabilitation group. More patients in orthogeriatric group discharged home compared with general rehabilitation group (70% vs 43%), but functional improvements were similar. For ARC residents discharged following acute admission, length of stay was short (median 6.5 day), but overall 180-day mortality was 7%. The not-ARC resident group discharged directly from hospital was less comorbid than the other groups with lower 180-day mortality (4%). Osteoporosis treatment rates were lower in patients discharged from acute admission (15-42%).
Mortality was highest in ARC residents discharged from acute orthopaedics. Patients admitted for orthogeriatric rehabilitation had shorter length of stay, lower 30-day mortality, were more likely to return home and most likely to be offered osteoporosis treatment (88%), noting less underlying comorbidity and better baseline functional status in this group. This paper supports further study (eg, randomised trials) to examine the effects of targeted post-surgical rehabilitation for patients with hip fracture and explore measures to increase uptake of osteoporosis treatment.
本研究通过数据集分析，探讨了与直接从医院出院的患者相比，接受康复治疗的髋部骨折老年患者的患者特征、结局和骨质疏松治疗情况。
本回顾性队列研究纳入了在一年内入住基督城医院的所有连续患者（65 岁及以上）。将患者分为以下四组进行比较：1）养老院居民（ARC）和 2）非 ARC 居民从急性骨科出院，以及 3）骨科老年病学或 4）普通老年病学康复出院。从医院数据仓库中提取临床数据，使用信号从噪声中提取。
在 12 个月内，有 415 名患者因髋部骨折入院。其中超过一半（n=282）转入住院康复治疗。30 天死亡率为 10%。骨科老年病学康复组和普通康复组 180 天死亡率分别为 7%和 8%。骨科老年病学康复组的住院时间短于普通康复组（中位数 12.9 天 vs 20.4 天）。骨科老年病学康复组 88%的患者接受了骨质疏松治疗，而普通康复组为 62%。骨科老年病学康复组出院回家的患者比例高于普通康复组（70% vs 43%），但功能改善情况相似。对于从急性入院出院的 ARC 居民，住院时间较短（中位数 6.5 天），但总体 180 天死亡率为 7%。从医院直接出院的非 ARC 居民组比其他组的合并症更少，180 天死亡率较低（4%）。从急性入院出院的患者骨质疏松治疗率较低（15-42%）。
从急性骨科出院的 ARC 居民死亡率最高。接受骨科老年病学康复治疗的患者住院时间更短，30 天死亡率更低，更有可能出院回家，且最有可能接受骨质疏松治疗（88%），这表明该组患者合并症较少，基线功能状态较好。本研究支持进一步研究（如随机试验），以检验针对髋部骨折患者的术后康复治疗效果，并探索提高骨质疏松治疗率的措施。
