Jt Comm J Qual Patient Saf. 2021 Apr;47(4):210-216. doi: 10.1016/j.jcjq.2020.12.005. Epub 2020 Dec 14.
Hip fractures affect a vulnerable population and are associated with high rates of morbidity, mortality, and resource utilization. Although postoperative complications are a known driver of mortality and resource utilization, the comparative impacts of specific complications on outcomes is unknown. This study assessed which complications are associated with the highest effects on mortality and resource utilization for older patients who undergo hip fracture repair.
Patients ≥ 65 years of age who underwent hip fracture repair during 2016-2017 included in the Hip Fracture Targeted ACS NSQIP (American College of Surgeons National Surgical Quality Improvement Program) database populated the data set. Prolonged hospitalization (≥ 75th percentile) and 30-day mortality and readmission were the primary outcomes. Population attributable fractions (PAFs) were used to quantify the anticipated reduction in the primary outcomes that would result from complete prevention of 10 postoperative complications.
Of 17,755 patients across 117 hospitals, 70.9% were female, 26.0% were over age 90, 22.8% had an American Society of Anesthesiologists (ASA) score of 4-5, and 53.9% presented with an intertrochanteric fracture. Postoperative delirium affected 29.8% of patients and was associated with death (PAF 18.0%; 95% confidence interval [CI] = 13.2-22.5), prolonged hospitalization (PAF 14.3%; 95% CI = 12.7-15.8), and readmission (PAF 15.0%; 95% CI = 11.3-18.6). Pneumonia affected 4.1% of patients and was associated with death (PAF 10.9%; 95% CI = 8.9-12.8), prolonged hospitalization (PAF 4.0%; 95% CI = 3.5-4.5), and readmission (PAF 9.1%; 95% CI = 7.5-10.7). The impact of the other eight complications was comparatively small.
Postoperative delirium and pneumonia are the highest-impact complications for older hip fracture repair patients. These complications should be prioritized in quality improvement efforts that target this patient population.
髋部骨折影响脆弱人群，与高发病率、死亡率和资源利用率相关。尽管术后并发症是导致死亡率和资源利用率升高的已知因素，但特定并发症对结局的影响尚不清楚。本研究评估了哪些并发症与接受髋部骨折修复的老年患者的死亡率和资源利用率升高关系最密切。
纳入 2016-2017 年美国外科医师学会国家外科质量改进计划（ACS NSQIP）髋部骨折靶向数据库中年龄≥65 岁的接受髋部骨折修复的患者，构成数据集。主要结局为住院时间延长（≥75 百分位数）和 30 天死亡率和再入院率。人群归因分数（PAF）用于量化完全预防 10 种术后并发症可使主要结局降低的预期幅度。
在 117 家医院的 17755 名患者中，70.9%为女性，26.0%年龄超过 90 岁，22.8%美国麻醉医师协会（ASA）评分为 4-5 级，53.9%为转子间骨折。术后谵妄影响 29.8%的患者，与死亡相关（PAF 18.0%；95%置信区间[CI] 13.2-22.5）、住院时间延长（PAF 14.3%；95%CI 12.7-15.8）和再入院（PAF 15.0%；95%CI 11.3-18.6）。肺炎影响 4.1%的患者，与死亡相关（PAF 10.9%；95%CI 8.9-12.8）、住院时间延长（PAF 4.0%；95%CI 3.5-4.5）和再入院（PAF 9.1%；95%CI 7.5-10.7）。其他 8 种并发症的影响相对较小。
术后谵妄和肺炎是老年髋部骨折修复患者影响最大的并发症。这些并发症应在针对该患者人群的质量改进工作中优先考虑。
