Division of Surgery, Department of Traumatology, University Medical Centre, Ljubljana, Slovenia.
Acta Chir Orthop Traumatol Cech. 2021;88(1):28-34.
PURPOSE OF THE STUDY The increasing number of hip fractures puts enormous demand on our level 1 trauma centre. Because we have to synchronize hip fracture treatment with all other injuries delays to surgery can occur. In this study, we analysed the reasons for delay to surgery and how it impacts on mortality of hip fracture patients in our institution. MATERIAL AND METHODS We retrospectively studied 641 patients operated for hip fractures in one year period. Investigated characteristics were: age, gender, American Society of Anaesthesiologists score (ASA), time of hospital admission, time of surgery, type of surgery, anticoagulant therapy (ACT) and non-routine pre-operative tests (NRPT). Trochanteric (TF) and femoral neck fractures (FNF) were analysed separately. The surgery in first 48 hours was considered early. The time of death was obtained from the federal database. Univariate and multivariable analysis were performed. P-values <0.05 were considered statistically significant. RESULTS All tested characteristics were significantly different in both time groups. Delay to surgery was significantly influenced by the type of surgery - arthroplasty, odds ratio (OR) 17.2, ACT (OR 6.9) and NRPT (OR 4.0) in FNF group of patients and by ACT (OR 31.1) and ASA (OR 2.2) in TF. 30-day mortality rate was 5.1% and 1-year mortality was 18.4%. ASA (OR 1.9), preinjury residence (OR 1.4) and age (OR 1.1) had statistical influence on survival, but not delay to surgery. CONCLUSIONS The majority of delays are due to unavailability of operative capacities, after patient optimization. We see solution in dedicated operation rooms and teams for hip fracture treatment. Mortality is influenced by the patients' characteristics, but not by delay to surgery. A multidisciplinary approach and skilled surgical teams are, besides early operation, the most important assurance of a good outcome. Key words: trochanteric fracture, femoral neck fracture, timing, mortality.
髋部骨折数量的增加给我们的 1 级创伤中心带来了巨大的需求。由于我们必须将髋部骨折的治疗与所有其他损伤同步进行，因此手术可能会延迟。在这项研究中，我们分析了手术延迟的原因以及它如何影响我们机构髋部骨折患者的死亡率。
我们对一年内接受髋部骨折手术的 641 名患者进行了回顾性研究。调查的特征包括：年龄、性别、美国麻醉医师协会评分（ASA）、入院时间、手术时间、手术类型、抗凝治疗（ACT）和非常规术前检查（NRPT）。转子间（TF）和股骨颈骨折（FNF）分别进行了分析。48 小时内的手术被认为是早期手术。死亡时间从联邦数据库中获得。进行了单变量和多变量分析。P 值<0.05 被认为具有统计学意义。
两组患者的所有测试特征均有显著差异。手术延迟的主要原因是手术类型-关节置换术，比值比（OR）为 17.2；在 FNF 组患者中，ACT（OR 6.9）和 NRPT（OR 4.0）也会导致手术延迟；在 TF 组中，ACT（OR 31.1）和 ASA（OR 2.2）也会导致手术延迟。30 天死亡率为 5.1%，1 年死亡率为 18.4%。ASA（OR 1.9）、受伤前居住地（OR 1.4）和年龄（OR 1.1）对生存有统计学影响，但对手术延迟没有影响。
大多数延迟是由于手术能力不足导致的，需要优化患者状况。我们认为在髋部骨折治疗方面，专用手术室和团队可以提供解决方案。死亡率受患者特征的影响，但不受手术延迟的影响。多学科方法和熟练的手术团队，除了早期手术外，还是确保良好预后的最重要保证。
转子间骨折，股骨颈骨折，时机，死亡率。
