Department of Surgery, Washington University School of Medicine, Saint Louis, Missouri; Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan.
Department of Surgery, Howard University Hospital, Washington DC.
J Surg Res. 2021 Oct;266:142-147. doi: 10.1016/j.jss.2021.03.027. Epub 2021 May 12.
Hip fractures are a major cause of morbidity and mortality in the elderly. The American Academy of Orthopedic Surgeons (AAOS) recommends surgical repair within 48 hours of admission, as this is associated with lower postoperative mortality and complications. This study demonstrates the association between patient demographics, level of care, and hospital region to delay in hip fracture repair in the elderly.
The National Trauma Data Bank (NTDB) was queried for elderly patients (age >65 years) who underwent proximal femoral fracture repair. Identified patients were subcategorized into two groups: hip fracture repair in <48 hours, and hip fracture repair > 48 hours after admission. Patient and hospital characteristics were collected. Outcome variables were timed from the day of admission to surgery and inpatient mortality.
Out of 69,532 patients, 28,031 were included after inclusion criteria were applied. 23,470 (83.7%) patients underwent surgical repair within 48 hours. The overall median time to procedure was 21 (interquartile range [IQR] 7-38) hours. Females were less likely to undergo a delay in hip fracture repair (odds ratio [OR; 95% confidence interval {CI}]: 0.82 [0.76-0.88], P< 0.05), and patients with higher Injury Severity Score (ISS ≥25) had higher odds of delay in surgical repair (OR; 95% CI: 1.56 [1.07-2.29], P< 0.05). Patients treated at hospitals in the Western regions of the United States had lower odds of delay, and those treated in the Northeast and the South had higher odds of delay compared to the hospitals in the Midwest (taken as standard). There was no association between trauma level designation and odds of undergoing delay in hip fracture repair.
Variables related to patient demographic and hospital characteristics are associated with delay in hip fracture repair in the elderly. This study delineates key determinants of delay in hip fracture repair in the elderly patients.
髋部骨折是老年人发病率和死亡率的主要原因。美国骨科医师学会（AAOS）建议在入院后 48 小时内进行手术修复，因为这与术后死亡率和并发症较低有关。本研究表明患者人口统计学特征、护理水平和医院所在地区与老年人髋部骨折修复的延迟之间存在关联。
从国家创伤数据库（NTDB）中查询接受股骨近端骨折修复的老年患者（年龄>65 岁）。将确定的患者分为两组：入院后 48 小时内进行髋部骨折修复，以及入院后 48 小时以上进行髋部骨折修复。收集患者和医院特征。结果变量从入院当天到手术时间和住院死亡率。
在纳入标准应用后，从 69532 名患者中纳入 28031 名患者。23470 名（83.7%）患者在 48 小时内接受了手术修复。总体中位数手术时间为 21 小时（四分位距 [IQR] 7-38 小时）。女性不太可能延迟髋部骨折修复（比值比[OR]；95%置信区间[CI]：0.82 [0.76-0.88]，P<0.05），损伤严重程度评分较高（ISS≥25）的患者手术修复延迟的可能性更高（OR；95%CI：1.56 [1.07-2.29]，P<0.05）。在美国西部地区医院接受治疗的患者发生延迟的可能性较低，而在美国东北部和南部地区接受治疗的患者发生延迟的可能性较高，与中西部地区的医院相比（作为标准）。创伤水平指定与髋部骨折修复延迟的可能性之间没有关联。
与患者人口统计学特征和医院特征相关的变量与老年人髋部骨折修复的延迟有关。本研究描述了老年患者髋部骨折修复延迟的关键决定因素。
