Shen Ching-Yi, Hsiao Chien-Han, Tsai Weide, Chang Wen-Han, Chen Tse-Hao
Department of Emergency Medicine, Mackay Memorial Hospital, Taipei 104, Taiwan.
Department of Medicine, Mackay Medical College, New Taipei City 252, Taiwan.
Int J Environ Res Public Health. 2021 Mar 11;18(6):2848. doi: 10.3390/ijerph18062848.
Early surgical intervention in hip fractures is associated with lower complications. This study aimed to determine the appropriate operation time among Asian geriatric patients. The data of 1118 elderly patients with hip fracture at Mackay Memorial Hospital from 1 January 2011, to 31 July 2019, were retrospectively examined. Association between operation waiting time and the occurrence of complications was calculated using a cubic spline model. Significantly increased incidence of pneumonia, myocardial infarction, and heart failure was observed in 30 and 90 days when the patient's surgical waiting time exceeded 36 h. The incidence rates of pneumonia across the early and delayed groups within 30 and 90 days were 4.4% vs. 7.9%, and 6.2% vs. 10.7%, those of myocardial infarction were 3.0% vs. 7.2%, and 5.7% vs. 9.3%, and those of heart failure were 15.2% vs. 26.8%, and 16.2% vs. 28.5%. Deep vein thrombosis and pulmonary embolism were not associated with surgical delay. The overall 30-day mortality rate was 5.4%, and no significant difference was observed when the surgical waiting time exceeded 36 h. In summary, operation waiting time exceeding 36-h was associated with increased rates of pneumonia, myocardial infarction, and heart failure in Asian geriatric patients undergoing hip fracture surgery.
髋部骨折的早期手术干预与较低的并发症发生率相关。本研究旨在确定亚洲老年患者的合适手术时间。对2011年1月1日至2019年7月31日在麦凯纪念医院的1118例老年髋部骨折患者的数据进行了回顾性研究。使用三次样条模型计算手术等待时间与并发症发生之间的关联。当患者的手术等待时间超过36小时时，在30天和90天时观察到肺炎、心肌梗死和心力衰竭的发生率显著增加。在30天和90天内，早期和延迟组的肺炎发生率分别为4.4%对7.9%，以及6.2%对10.7%；心肌梗死发生率分别为3.0%对7.2%，以及5.7%对9.3%；心力衰竭发生率分别为15.2%对26.8%，以及16.2%对28.5%。深静脉血栓形成和肺栓塞与手术延迟无关。总体30天死亡率为5.4%，当手术等待时间超过36小时时未观察到显著差异。总之，对于接受髋部骨折手术的亚洲老年患者，手术等待时间超过36小时与肺炎、心肌梗死和心力衰竭发生率增加相关。
