髋部骨折后 30 天的生存和康复与活动时间及痴呆的关系：一项英国数据库研究。
The 30-day survival and recovery after hip fracture by timing of mobilization and dementia : a UK database study.
机构信息
Department of Population Health Sciences, School of Population Health & Environmental Sciences, Faculty of Life Science and Medicine, London, UK.
Guy's and St. Thomas's National Health Service Foundation Trust, London, UK.
出版信息
Bone Joint J. 2021 Jul;103-B(7):1317-1324. doi: 10.1302/0301-620X.103B7.BJJ-2020-2349.R1.
AIMS
The aim of this study to compare 30-day survival and recovery of mobility between patients mobilized early (on the day of, or day after surgery for a hip fracture) and patients mobilized late (two days or more after surgery), and to determine whether the presence of dementia influences the association between the timing of mobilization, 30-day survival, and recovery.
METHODS
Analysis of the National Hip Fracture Database and hospital records for 126,897 patients aged ≥ 60 years who underwent surgery for a hip fracture in England and Wales between 2014 and 2016. Using logistic regression, we adjusted for covariates with a propensity score to estimate the association between the timing of mobilization, survival, and recovery of walking ability.
RESULTS
A total of 99,667 patients (79%) mobilized early. Among those mobilized early compared to those mobilized late, the weighted odds ratio of survival was 1.92 (95% confidence interval (CI) 1.80 to 2.05), of recovering outdoor ambulation was 1.25 (95% CI 1.03 to 1.51), and of recovering indoor ambulation was 1.53 (95% CI 1.32 to 1.78) by 30 days. The weighted probabilities of survival at 30 days post-admission were 95.9% (95% CI 95.7% to 96.0%) for those who mobilized early and 92.4% (95% CI 92.0% to 92.8%) for those who mobilized late. The weighted probabilities of regaining the ability to walk outdoors were 9.7% (95% CI 9.2% to 10.2%) and indoors 81.2% (95% CI 80.0% to 82.4%), for those who mobilized early, and 7.9% (95% CI 6.6% to 9.2%) and 73.8% (95% CI 71.3% to 76.2%), respectively, for those who mobilized late. Patients with dementia were less likely to mobilize early despite observed associations with survival and ambulation recovery for those with and without dementia.
CONCLUSION
Early mobilization is associated with survival and recovery for patients (with and without dementia) after hip fracture. Early mobilization should be incorporated as a measured indicator of quality. Reasons for failure to mobilize early should also be recorded to inform quality improvement initiatives. Cite this article: 2021;103-B(7):1317-1324.
目的
本研究旨在比较髋部骨折患者早期（手术当天或术后一天）和晚期（术后两天或以上）活动与 30 天生存率和活动能力恢复之间的关系，并确定痴呆症的存在是否会影响活动时机、30 天生存率和活动能力恢复之间的关联。
方法
对英格兰和威尔士 2014 年至 2016 年间接受髋部骨折手术的 126897 名年龄≥60 岁患者的国家髋部骨折数据库和医院记录进行分析。使用逻辑回归，我们通过倾向评分调整协变量，以估计活动时机、生存和行走能力恢复之间的关联。
结果
共有 99667 例（79%）患者早期活动。与晚期活动相比，早期活动的患者生存率的加权比值比为 1.92（95%置信区间[CI]1.80 至 2.05），恢复户外活动能力的比值比为 1.25（95%CI1.03 至 1.51），恢复室内活动能力的比值比为 1.53（95%CI1.32 至 1.78），30 天内。早期活动患者的 30 天入院生存率的加权概率为 95.9%（95%CI95.7%至 96.0%），晚期活动患者为 92.4%（95%CI92.0%至 92.8%）。早期活动患者恢复户外行走能力的加权概率为 9.7%（95%CI9.2%至 10.2%），室内行走能力为 81.2%（95%CI80.0%至 82.4%），晚期活动患者为 7.9%（95%CI6.6%至 9.2%）和 73.8%（95%CI71.3%至 76.2%）。尽管痴呆症患者与有痴呆症和无痴呆症患者的生存率和活动能力恢复相关，但他们不太可能早期活动。
结论
髋部骨折后，早期活动与患者（有或无痴呆症）的生存率和活动能力恢复有关。早期活动应作为衡量质量的指标。还应记录未能早期活动的原因，以告知质量改进计划。引用本文：2021；103-B（7）：1317-1324.
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