Department of Surgery-Traumatology University of Groningen, University Medical Center Groningen, P.O. Box 300019700 RB Groningen, The Netherlands.
Department of Surgery-Traumatology University of Groningen, University Medical Center Groningen, P.O. Box 300019700 RB Groningen, The Netherlands.
Injury. 2021 Jul;52(7):1819-1825. doi: 10.1016/j.injury.2021.04.044. Epub 2021 Apr 16.
Hip fracture surgery is among the most performed surgical procedures in elderly patients. Mortality rates are high, however, and patients often fail to live independently following a hip fracture. To improve outcome, multidisciplinary care pathways have been initiated, but longer-term results are lacking. Aim of this study was to compare functional outcome and living situation six months after hip fracture treatment with and without a care pathway.
A multicentre prospective controlled trial was conducted with three hospitals: in one hospital patients were treated with a care pathway, in the other hospitals patients received usual care. All patients aged ≥ 60 years with a hip fracture were asked to participate. Besides basic characteristics, health-related quality of life (EQ-5D) and performance scores of activities of daily living (Katz Index and Lawton IADL) were assessed. Differences in scores were analysed using linear regression. Propensity score adjustment was used to correct for differences between the care pathway and the usual care group. Missing data were imputed.
No differences in rate of return to prefracture ADL level were found between patients in the care pathway group and the usual care group. The percentage of participants in the same situation as before the fracture was the same in both treatment groups (81%). There were no significant differences in quality of life, activities of daily living or mortality (15% vs 10%, p = 0.17), but hospital stay in the care pathway group was significantly shorter (median 7 vs 10 days).
Treatment of elderly patients with a hip fracture is commonly organised in care pathways. Although short-term advantages are reported, positive effects on longer-term functional results could not be proven in our study. This study confirmed a shorter hospital stay in the care pathway group, which potentially may lead to a reduction in costs.
Functional outcome and living situation six months after a hip fracture is the same for patients treated with or without a care pathway.
髋部骨折手术是老年患者最常进行的手术之一。然而，死亡率仍然很高，而且许多患者在髋部骨折后无法独立生活。为了改善结果，已经启动了多学科护理途径，但缺乏长期结果。本研究的目的是比较有和没有护理途径的髋部骨折治疗后 6 个月的功能结果和生活状况。
进行了一项多中心前瞻性对照试验，涉及 3 家医院：一家医院的患者接受了护理途径治疗，另两家医院的患者接受了常规护理。所有年龄≥60 岁、髋部骨折的患者均被邀请参加。除了基本特征外，还评估了健康相关生活质量（EQ-5D）和日常生活活动（Katz 指数和 Lawton IADL）的表现评分。使用线性回归分析评分差异。使用倾向评分调整来校正护理途径组和常规护理组之间的差异。对缺失数据进行了插补。
在护理途径组和常规护理组的患者中，回到骨折前 ADL 水平的比例没有差异。在两组治疗中，骨折前情况相同的患者比例相同（81%）。生活质量、日常生活活动或死亡率没有显著差异（15%对 10%，p=0.17），但护理途径组的住院时间明显缩短（中位数 7 对 10 天）。
老年髋部骨折患者的治疗通常组织在护理途径中。尽管报告了短期优势，但本研究未能证明对长期功能结果有积极影响。本研究证实了护理途径组的住院时间较短，这可能会降低成本。
髋部骨折治疗后 6 个月的功能结果和生活状况对于接受或不接受护理途径的患者相同。
