Schneider Andrew M, Mucharraz Carlos, Denyer Steven, Brown Nicholas M
Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, 2160 S. First Ave, Maywood, IL, 60153, USA.
J Clin Orthop Trauma. 2022 Feb 2;26:101785. doi: 10.1016/j.jcot.2022.101785. eCollection 2022 Mar.
Recent studies show increasing mortality rates of geriatric femoral neck fracture patients with delays in operative treatment greater than 48 hours from injury. A less extensively studied area in this population is the effect of length of inpatient hospital stay (LOS) on outcomes. The purpose of this study was to determine the association of LOS after arthroplasty for geriatric femoral neck fractures with 30-day mortality risk.
This study is a retrospective review using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP), a nationally validated, outcomes-based database incorporating data from over 700 geographically diverse medical centers. It included 9005 patients, 65 years of age or older, who underwent either hemiarthroplasty or total hip arthroplasty for a femoral neck fracture between 2011 and 2018. Using multivariate analysis, risk of 30-day mortality based on surgery-to-discharge time was determined, expressed as odds ratios (OR) with 95% confidence intervals (CI).
After controlling for sex, BMI, age, surgical procedure, American Society of Anesthesiologists (ASA) classification, and discharge location, the risk of mortality after discharge was increased with longer post-surgical length of stay [OR 2.5, P < .001].
Prolonged LOS after arthroplasty for geriatric femoral neck fractures is associated with increased 30-day mortality risk. Efforts made to target and mitigate modifiable risk factors responsible for delaying discharge may improve early outcomes in this population.
近期研究表明，老年股骨颈骨折患者手术治疗延迟超过受伤后48小时，死亡率呈上升趋势。在这一人群中，住院时间长短对预后的影响是一个研究较少的领域。本研究的目的是确定老年股骨颈骨折置换术后住院时间与30天死亡风险之间的关联。
本研究是一项回顾性研究，使用美国外科医师学会国家外科质量改进计划（ACS-NSQIP），这是一个经过全国验证的、基于结果的数据库，纳入了来自700多个地理位置不同的医疗中心的数据。研究包括9005例65岁及以上的患者，他们在2011年至2018年间因股骨颈骨折接受了半髋关节置换术或全髋关节置换术。使用多变量分析，确定基于手术至出院时间的30天死亡风险，以比值比（OR）和95%置信区间（CI）表示。
在控制了性别、体重指数、年龄、手术方式、美国麻醉医师协会（ASA）分级和出院地点后，出院后死亡风险随着术后住院时间的延长而增加[OR 2.5，P <.001]。
老年股骨颈骨折置换术后住院时间延长与30天死亡风险增加相关。针对并减轻导致出院延迟的可改变风险因素的努力，可能会改善这一人群的早期预后。
