老年髋部骨折患者在骨科骨折中心与常规治疗后：有哪些获益？一项大型国际前瞻性多中心研究的结果。
Geriatric fracture centre vs usual care after proximal femur fracture in older patients: what are the benefits? Results of a large international prospective multicentre study.
机构信息
Formerly: Department of Trauma Surgery and Sports Medicine, Medical University Innsbruck, Innsbruck, Austria.
Preclinical Clinical Medical, Depuy Synthes, Zuchwil, Switzerland.
出版信息
BMJ Open. 2021 May 10;11(5):e039960. doi: 10.1136/bmjopen-2020-039960.
OBJECTIVE
The aim of this study was to determine the effect of treatment in geriatric fracture centres (GFC) on the incidence of major adverse events (MAEs) in patients with hip fractures compared with usual care centres (UCC). Secondary objectives included hospital-workflow and mobility-related outcomes.
DESIGN
Cohort study recruiting patients between June 2015 and January 2017. Follow-up was 1 year.
SETTING
International (six countries, three continents) multicentre study.
PARTICIPANTS
281 patients aged ≥70 with operatively treated proximal femur fractures.
INTERVENTIONS
Treatment in UCCs (n=139) or GFCs (n=142), that is, interdisciplinary treatment including regular geriatric consultation and daily physiotherapy.
OUTCOME MEASURES
Primary outcome was occurrence of prespecified MAEs, including delirium. Secondary outcomes included any other adverse events, time to surgery, time in acute ward, 1-year mortality, mobility, and quality of life.
RESULTS
Patients treated in GFCs (n=142) had a mean age of 81.9 (SD, 6.6) years versus 83.9 (SD 6.9) years in patients (n=139) treated in UCCs (p=0.013) and a higher mean Charlson Comorbidity Index of 2.0 (SD, 2.1) versus 1.2 (SD, 1.5) in UCCs (p=0.001). More patients in GFCs (28.2%) experienced an MAE during the first year after surgery compared with UCCs (7.9%) with an OR of 4.56 (95% CI 2.23 to 9.34, p<0.001). Analysing individual MAEs, this was significant for pneumonia (GFC: 9.2%; UCC: 2.9%; OR, 3.40 (95% CI 1.08 to 10.70), p=0.027) and delirium (GFC: 11.3%; UCC: 2.2%, OR, 5.76 (95% CI 1.64 to 20.23), p=0.002).
CONCLUSIONS
Contrary to our study hypothesis, the rate of MAEs was higher in GFCs than in UCCs. Delirium was revealed as a main contributor. Most likely, this was based on improved detection rather than a truly elevated incidence, which we interpret as positive effect of geriatric comanagement.
TRIAL REGISTRATION NUMBER
ClinicalTrials.gov: NCT02297581.
目的
本研究旨在比较老年骨折中心（GFC）与常规护理中心（UCC）治疗对髋部骨折患者主要不良事件（MAE）发生率的影响。次要目标包括医院工作流程和与移动能力相关的结果。
设计
2015 年 6 月至 2017 年 1 月间进行的队列研究。随访时间为 1 年。
地点
国际（六个国家，三大洲）多中心研究。
参与者
281 名年龄≥70 岁、接受手术治疗的股骨近端骨折患者。
干预
UCC 组（n=139）或 GFC 组（n=142）接受治疗，即包括定期老年科会诊和每日物理治疗在内的多学科治疗。
主要结局指标
主要结局指标为出现既定 MAE，包括谵妄。次要结局指标包括任何其他不良事件、手术时间、急性病房时间、1 年死亡率、移动能力和生活质量。
结果
GFC 组（n=142）患者的平均年龄为 81.9（标准差，6.6）岁，UCC 组（n=139）患者为 83.9（标准差，6.9）岁（p=0.013），GFC 组的平均 Charlson 合并症指数为 2.0（标准差，2.1），UCC 组为 1.2（标准差，1.5）（p=0.001）。与 UCC 组（7.9%）相比，GFC 组（28.2%）更多患者在术后 1 年内发生 MAE，OR 为 4.56（95%CI 2.23 至 9.34，p<0.001）。分析各个 MAE，GFC 组的肺炎（9.2%；UCC 组：2.9%；OR，3.40（95%CI 1.08 至 10.70），p=0.027）和谵妄（11.3%；UCC 组：2.2%；OR，5.76（95%CI 1.64 至 20.23），p=0.002）发生率更高，差异有统计学意义。
结论
与我们的研究假设相反，GFC 组的 MAE 发生率高于 UCC 组。谵妄是一个主要的贡献因素。很可能，这是基于更好的检测，而不是真正的发病率增加，我们将其解释为老年共管理的积极影响。
试验注册
ClinicalTrials.gov：NCT02297581。
Zotero 插件