Department of Orthopaedic Surgery, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
Department of Orthopaedic Surgery, JPNA Trauma Centre, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
Arch Osteoporos. 2021 Jan 6;16(1):7. doi: 10.1007/s11657-020-00858-6.
Early hip fracture surgery is recommended to decrease the morbidity and mortality. The extent to which such guidelines are being followed in developing countries like India is unknown. About 20% of the patients presented to hospital after 24 hours of injury, and only one-third had surgery within 48 hours of presentation.
Early hip fracture surgery is recommended to decrease the morbidity and mortality following hip fractures. Understanding the factors responsible for delay in surgery is important to improve the quality of hip fracture care. This study was conducted to study the factors causing delay in elderly hip fracture surgery in India.
In this prospective study, 272 consecutive hip fracture surgeries at a single hospital were included. Delayed surgery was defined as when the time to surgery (reaching hospital to start of incision) was more than 48 hours. Additionally, the total time to surgery (including time taken for patients to reach hospital after injury) was studied. Factors associated with delayed surgery were assessed using regression models.
Eighty-seven (32%) patients had a surgery within 48 hours of presentation. Majority of the patients had a delay (82%, N = 151/185) due to one or more medical reasons. Fifty-four (20%) patients presented to hospital after 24 hours of injury. The mean total time to surgery was 112 ± 90 hours with time after reaching hospital contributing to 78% of the total time. Multiple comorbidities (odds ratio, OR = 3.47 [1.42-8.45]), fall as mode of injury (OR = 3.54 [1.61-7.80]), requiring an additional investigation (OR = 10.4 [3.4-31.81]), and requiring arthroplasty (OR = 40.57 [7.01-234.97]) were independently associated with delayed surgery.
Only about one-third of the patients received surgery within 48 hours of reaching the hospital, and about 20% of the patients presented to hospital after 24 hours of injury. Delayed surgery was primarily due to medical comorbidities. Hospitals should establish protocols to ensure faster optimization of patients.
早期髋关节骨折手术被推荐用于降低发病率和死亡率。在印度等发展中国家，这种指南的遵循程度尚不清楚。大约 20%的患者在受伤后 24 小时内到医院就诊，只有三分之一的患者在就诊后 48 小时内接受手术。
早期髋关节骨折手术被推荐用于降低髋关节骨折后的发病率和死亡率。了解导致手术延迟的因素对于提高髋关节骨折护理质量很重要。本研究旨在研究印度老年髋关节骨折手术延迟的原因。
本前瞻性研究纳入了一家医院的 272 例连续髋关节骨折手术。手术延迟定义为手术时间（到达医院至开始切口）超过 48 小时。此外，还研究了总手术时间（包括患者受伤后到达医院所需的时间）。使用回归模型评估与手术延迟相关的因素。
87 例（32%）患者在就诊后 48 小时内接受手术。大多数患者（82%，N=151/185）由于一个或多个医疗原因而延迟手术。54 例（20%）患者在受伤后 24 小时内到医院就诊。总手术时间平均为 112±90 小时，到达医院后的时间占总时间的 78%。合并多种疾病（比值比，OR=3.47[1.42-8.45]）、跌倒为损伤方式（OR=3.54[1.61-7.80]）、需要额外检查（OR=10.4[3.4-31.81]）和需要关节置换术（OR=40.57[7.01-234.97]）与手术延迟独立相关。
只有约三分之一的患者在到达医院后 48 小时内接受手术，约 20%的患者在受伤后 24 小时内到医院就诊。手术延迟主要是由于医疗合并症。医院应制定协议，确保患者更快地得到优化。
