Department of Orthopaedic Surgery, University of California, 500 Parnassus Ave MU 320-W, San Francisco, CA, 94143, USA.
Division of Geriatrics, Department of Medicine, University of California, San Francisco, USA.
Arch Orthop Trauma Surg. 2022 Jul;142(7):1491-1497. doi: 10.1007/s00402-020-03699-7. Epub 2021 Mar 2.
Interdisciplinary standardized protocols for the care of patients with hip fractures have been shown to improve outcomes. A hip fracture protocol was implemented at our institution to standardize care, focusing on emergency care, pre-operative medical management, operative timing, and geriatrics co-management. The aim of this study was to evaluate the efficacy of this protocol.
We conducted a retrospective review of adult patients admitted to a single tertiary care institution who underwent operative management of a hip fracture between July 2012 and March 2020. Comparison of patient characteristics, hospitalization characteristics, and outcomes were performed between patients admitted before and after protocol implementation in 2017.
A total of 517 patients treated for hip fracture were identified: 313 before and 204 after protocol implementation. Average age, average Charlson Comorbidity Index, percent female gender, and distribution of hip fracture diagnosis did not vary significantly between groups. There was a significant reduction in time from admission to surgical management, from 37.0 ± 47.7 to 28.5 ± 27.1 h (p = 0.0016), and in the length of hospital stay, from 6.3 ± 6.5 to 5.4 ± 4.0 days (p = 0.0013). The percentage of patients whose surgeries were performed under spinal anesthesia increased from 12.5 to 26.5% (p = 0.016). There was no difference in 90-day readmission rate or mortality at 30 days, 90 days, or 1 year between groups.
With the implementation of an interdisciplinary hip fracture protocol, we observed significant and sustained reductions in time to surgery and hospital length of stay, important metrics in hip fracture management, without increased readmission or mortality. This has implications to minimize health care costs and improve outcomes for our aging population.
III, therapeutic.
多项研究表明，多学科标准化的髋部骨折患者护理协议可改善治疗效果。我院实施了髋部骨折协议，以规范治疗，重点关注急救、术前医学管理、手术时机和老年病共管。本研究旨在评估该协议的疗效。
我们对 2012 年 7 月至 2020 年 3 月期间在一家三级保健机构接受手术治疗的成人髋部骨折患者进行了回顾性研究。比较了 2017 年实施协议前后入院患者的患者特征、住院特征和结局。
共确定 517 例髋部骨折患者：协议实施前 313 例，实施后 204 例。两组患者的平均年龄、平均 Charlson 合并症指数、女性百分比和髋部骨折诊断分布无显著差异。从入院到手术管理的时间显著缩短，从 37.0±47.7 小时降至 28.5±27.1 小时（p=0.0016），住院时间也显著缩短，从 6.3±6.5 天降至 5.4±4.0 天（p=0.0013）。接受椎管内麻醉手术的患者比例从 12.5%增加到 26.5%（p=0.016）。两组患者的 90 天再入院率或 30 天、90 天和 1 年死亡率无差异。
实施多学科髋部骨折协议后，我们观察到手术时间和住院时间明显持续缩短，这是髋部骨折管理的重要指标，且无再入院或死亡率增加。这对降低我们老龄化人口的医疗保健成本和改善治疗结果具有重要意义。
III，治疗性。
