Liverpool and Broadgreen University Hospital Trust, UK; ST7 in Trauma and Orthopaedics, Mersey Deanery.
Liverpool and Broadgreen University Hospital Trust, UK; Consultant T&O, Liverpool University Hospitals NHS Foundation Trust, UK.
Injury. 2021 Oct;52(10):3011-3016. doi: 10.1016/j.injury.2021.01.041. Epub 2021 Jan 29.
According to the National Hip Fracture Database (NHFD), in 2018 31.4% of patients with displaced intracapsular neck of femur (NOF) fracture who, National Institute for Health and Care Excellence (NICE) viewed eligible for total hip replacement (THR), received this operation. We aimed to identify the compliance of performing THR for those patients in our unit and identify the reasons for proceeding with the alternative type of surgery.
A five-year retrospective review of eligible patients was conducted between January 2014 and Dec 2018. Statistical analysis was performed between groups who did or didn't receive THR. Reasons for not performing THR were identified from pre-operative ward rounds notes.
In 2018 our unit performed THR for 44% of eligible cases. This was the highest result over five-years and higher than the national average. Out of the 348 eligible cases, pathological or undisplaced intracapsular fractures were excluded. Reminder received THR (138), hip hemiarthroplasty (166) or internal fixation (11). The average age was 77. Younger patients were more likely to receive THR than 80 years or older (p<0.05). THR group scored 0.4 points higher on AMTS and 0.2 lower on ASA scale then non-THR group (9.8 vs. 9.4 and 2.7 vs. 2.5 respectively). Mean time to surgery was 1.24 days with no significant difference between THR and non-THR group (1.6 vs. 1.1) but a slight delay to surgery during the weekends was noted (1.3 vs 1.8 days). Reasons for not performing THR were well documented as a combination of mobility restrictions and serious medical comorbidities. Retrospectively we judged the surgical decision making to be correct in 95% of cases.
Annual NHFD report comments on poor national and individual hospital's compliance with NICE guidelines without allowing surgeons to justify their choice of the procedure undertaken. Surgical decisions are made in a highly specialised multi-disciplinary environment taking into consideration individual patient's frailty and potential morbidity. Details of those discussions should be collected in NHFD to allow further analysis of reasons why surgeons decide not to offer THR to a patient NHFD views as eligible for this procedure. This could help in understanding the complex factors impacting on decision making in those cases.
Level III.
根据国家髋关节骨折数据库（NHFD），2018 年，31.4%符合国家卫生与保健卓越研究所（NICE）标准的移位性囊内股骨颈（NOF）骨折患者接受了全髋关节置换术（THR）。我们旨在确定我院单位对这些患者进行 THR 的执行情况，并确定选择其他手术类型的原因。
对 2014 年 1 月至 2018 年 12 月期间符合条件的患者进行了为期 5 年的回顾性研究。对接受和未接受 THR 的患者进行了组间统计分析。从术前病房查房记录中确定未进行 THR 的原因。
2018 年，我院单位对 44%符合条件的患者进行了 THR。这是五年来的最高结果，高于全国平均水平。在 348 名符合条件的患者中，排除了病理性或未移位的囊内骨折。收到 THR 提醒（138）、髋关节半髋关节置换术（166）或内固定（11）。平均年龄为 77 岁。较年轻的患者比 80 岁或以上的患者更有可能接受 THR（p<0.05）。THR 组 AMTS 评分高 0.4 分，ASA 评分低 0.2 分，而非 THR 组 AMTS 评分低 0.4 分，ASA 评分高 0.2 分（分别为 9.8 分和 9.4 分，2.7 分和 2.5 分）。手术时间平均为 1.24 天，THR 组和非 THR 组之间无显著差异（1.6 天和 1.1 天），但周末手术时间略有延迟（1.3 天和 1.8 天）。未进行 THR 的原因有明确记录，主要是由于活动受限和严重的合并症。回顾性地，我们判断 95%的手术决策是正确的。
NHFD 年度报告对全国和个别医院对 NICE 指南的依从性较差提出了评论，不允许外科医生为他们选择的手术提供依据。手术决策是在高度专业化的多学科环境中做出的，考虑到了患者的脆弱性和潜在的发病率。NHFD 应收集这些讨论的详细信息，以便进一步分析外科医生决定不向 NHFD 认为符合该手术条件的患者提供 THR 的原因。这有助于理解影响这些病例决策的复杂因素。
III 级。
