髋部骨折手术后早期术后访视有价值吗？
Is There Value in Early Postoperative Visits Following Hip Fracture Surgery?
作者信息
Ganta Abhishek, Dedhia Nicket, Ranson Rachel A, Robitsek Jonathan, Hsu Joseph R, Konda Sanjit R, Egol Kenneth A
机构信息
Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY, USA.
Department of Orthopedic Surgery, Jamaica Hospital Medical Center, Queens, New York, NY, USA.
出版信息
Geriatr Orthop Surg Rehabil. 2021 Feb 14;12:2151459320987705. doi: 10.1177/2151459320987705. eCollection 2021.
INTRODUCTION
Despite the recommendation for postoperative orthopedic follow-up after a hip fracture in elderly patients, many patients do not return for these visits. In this study, we attempt to determine if early follow-up (<4 weeks post-discharge) changes orthopedic post-operative management.
MATERIALS AND METHODS
1232 patients aged > 55 years old who underwent operative fixation for hip fractures were enrolled into an orthopedic trauma registry and followed from hospitalization through one year. Demographics, comorbidities, injury severity, and hospital course data were collected. Need for readmission and orthopedic follow-up were ascertained through chart review.
RESULTS
417 patients (33.8%) patients did not return for any follow-up and 30 (2.4%) patients died <30 days from discharge. 370 (45.5%) patients had early orthopedic follow-up ≤28 days after discharge. 317 (38.9%) patients were seen ≥29 days after discharge (late follow-up). 127 (15.6%) patients returned for isolated non-orthopedic care. There were 23 (6.2%) readmissions in the early group, 17 (5.4%) in the late group, and 24 (18.9%) in the no follow-up group (p < 0.001). Patients discharged home were more likely to present for early follow-up compared to those with late and non-orthopedic follow-up (p = 0.002), however there was no difference in readmission rates between those discharged home vs. SNFs/SARs.
DISCUSSION
Patients who received isolated non-orthopedic follow-up within 4 weeks of surgery experienced more hospital readmissions than those with follow-up in that time period; however, these readmissions were primarily due to medical issues. There was no difference in orthopedic-related readmissions and changes in orthopedic management between groups. Patients discharged to SNFs/SARs did not present for early orthopedic as often as those discharged home.
CONCLUSION
Early orthopedic follow up after hip fracture care does not change post-operative management in these patients and has implications for value-based care.
LEVEL OF EVIDENCE
Prognostic Level III.
引言
尽管建议对老年髋部骨折患者进行术后骨科随访，但许多患者并未返回进行这些复诊。在本研究中，我们试图确定早期随访（出院后<4周）是否会改变骨科术后管理。
材料与方法
1232例年龄>55岁的髋部骨折手术固定患者被纳入骨科创伤登记系统，并从住院开始随访一年。收集人口统计学、合并症、损伤严重程度和住院病程数据。通过病历审查确定再次入院和骨科随访的需求。
结果
417例患者（33.8%）未返回进行任何随访，30例患者（2.4%）出院后<30天死亡。370例患者（45.5%）在出院后≤28天进行了早期骨科随访。317例患者（38.9%）在出院≥29天后接受了随访（晚期随访）。127例患者（15.6%）返回接受单纯非骨科护理。早期组有23例（6.2%）再次入院，晚期组有17例（5.4%），无随访组有24例（18.9%）（p<0.001）。与晚期和非骨科随访患者相比，出院回家的患者更有可能接受早期随访（p=0.002），然而，出院回家患者与入住熟练护理机构/康复机构患者的再次入院率没有差异。
讨论
在术后4周内接受单纯非骨科随访的患者比在此期间接受随访的患者经历更多的再次入院；然而，这些再次入院主要是由于医疗问题。各组之间在骨科相关再次入院和骨科管理变化方面没有差异。出院到熟练护理机构/康复机构的患者不像出院回家的患者那样经常接受早期骨科随访。
结论
髋部骨折护理后的早期骨科随访不会改变这些患者的术后管理，并且对基于价值的护理有影响。
证据水平
预后III级。
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