Department of Surgery, Diakonessenhuis Utrecht, Utrecht, The Netherlands.
Department of Orthopaedic Trauma, Lucerne Cantonal Hospital, Spitalstrasse, CH-6000, Luzern, Switzerland.
Eur J Trauma Emerg Surg. 2022 Aug;48(4):2927-2936. doi: 10.1007/s00068-021-01626-y. Epub 2021 Mar 10.
Many studies have focussed on the implementation and outcomes of geriatric care pathways (GCPs); however, little is known about the possible impact of clinical practices on these pathways. A comparison was made between two traumageriatric care models, one Swiss (CH) and one Dutch (NL), to assess whether these models would perform similarly despite the possible differences in local clinical practices.
This cohort study included all patients aged 70 years or older with a unilateral hip fracture who underwent surgery in 2014 and 2015. The primary outcomes were mortality and complications. Secondary outcomes were time to surgical intervention, hospital length of stay (HLOS), differences in surgical treatment and the number of patients who needed secondary surgical intervention.
A total of 752 patients were included. No differences were seen in mortality at 30 days, 90 days and 1 year post-operatively. In CH, fewer patients had a complicated course (43.5% vs. 51.3%; p = 0.048) and fewer patients were diagnosed with delirium (7.9% vs. 18.3%; p < 0.01). More myocardial infarctions (3.8% vs. 0.4%; p < 0.01) and red blood cell transfusions (27.2% vs. 13.3%; p < 0.01) were observed in CH and HLOS in CH was longer (Mdn difference: - 2; 95% CI - 3 to - 2). Furthermore, a difference in anaesthetic technique was found, CH performed more open reductions and augmentations than NL and surgeons in CH operated more often during out-of-office hours. Also, surgery time was significantly longer in CH (Mdn difference: - 62; 95% CI - 67 to - 58). No differences were seen in the number of patients who needed secondary surgical interventions.
This cross-cultural comparison of GCPs for geriatric hip fracture patients showed that quality of care in terms of mortality was equal. The difference in complicated course was mainly caused by a difference in delirium diagnosis. Differences were seen in surgical techniques, operation duration and timing. These clinical practices did not influence the outcome.
许多研究都集中在老年护理途径（GCP）的实施和结果上；然而，对于临床实践对这些途径的可能影响知之甚少。对瑞士（CH）和荷兰（NL）两种创伤老年护理模式进行了比较，以评估尽管当地临床实践可能存在差异，但这些模式是否会表现出相似的效果。
本队列研究纳入了所有 2014 年和 2015 年接受单侧髋部骨折手术的 70 岁及以上患者。主要结局是死亡率和并发症。次要结局是手术干预时间、住院时间（HLOS）、手术治疗差异以及需要二次手术干预的患者数量。
共纳入 752 例患者。术后 30 天、90 天和 1 年的死亡率无差异。在 CH，复杂病程的患者更少（43.5% vs. 51.3%；p=0.048），谵妄诊断更少（7.9% vs. 18.3%；p<0.01）。CH 组心肌梗死（3.8% vs. 0.4%；p<0.01）和红细胞输注（27.2% vs. 13.3%；p<0.01）更多，CH 的 HLOS 更长（中位数差异：-2；95%CI-3 至-2）。此外，还发现麻醉技术存在差异，CH 比 NL 更常进行开放性复位和增强，CH 的外科医生更常在非办公时间进行手术。此外，CH 的手术时间明显更长（中位数差异：-62；95%CI-67 至-58）。需要二次手术干预的患者数量无差异。
这项针对老年髋部骨折患者 GCP 的跨文化比较表明，在死亡率方面，护理质量是相等的。复杂病程的差异主要是由于谵妄诊断的差异造成的。在手术技术、手术持续时间和时间方面存在差异。这些临床实践并未影响结果。
