General Surgery Program, UCF/HCA College of Medicine, Ocala, FL, USA.
Ocala Regional Medical Center, Ocala, FL, USA.
Am Surg. 2023 May;89(5):1821-1828. doi: 10.1177/00031348211067994. Epub 2022 Mar 14.
Isolated hip fractures are a common orthopedic injury in the elderly population. Estimates are that there will be over 21 million hip fractures globally by 2050. Current recommendations are early operative fixation within 48 hours. Despite evidence showing that fixation of hip fractures within 24 hours is beneficial in the elderly population, the effect this has on the nonagenarian population has yet to be examined.
This is a single institution retrospective cohort study examining isolated hip fractures from 2014 to 2020 from an American College of Surgeons verified trauma center. Patients ≥65 years old with IHF were included. A total number of 1150 isolated hip fracture patients 65 years or older were included in this study. Three cohorts were examined: (1) patients ≥90 years old; (2) patients 65-89 years old; and (3) patients stratified by ≥90 vs 65-75 years old and ≥90 vs 75-89 years old. Patients were then sub stratified by timing of surgery whether it was performed ≤24 hours or >24 hours. The primary outcome was inpatient mortality.
Nonagenarians who had delayed surgery had higher mortality rates compared to nonagenarians with early surgery (15.2% vs 4.2%; 02). Patients aged 65-75 had higher complication rates with delayed surgery (12.9% vs 4.1%; 01) as did those aged 76-89 (9.0% vs 3.2%, 004).
Early surgical intervention of isolated hip fractures in the nonagenarian population within 24 hours is associated with good clinical outcomes as well as a lower inpatient mortality that approaches significance.
孤立性髋部骨折是老年人中常见的骨科损伤。据估计，到 2050 年，全球将有超过 2100 万例髋部骨折。目前的建议是在 48 小时内进行早期手术固定。尽管有证据表明，在老年人中，24 小时内固定髋部骨折是有益的，但这对 90 岁以上人群的影响尚未得到检验。
这是一项单中心回顾性队列研究，研究了 2014 年至 2020 年期间来自美国外科医师学会认证创伤中心的孤立性髋部骨折。纳入年龄≥65 岁、有 IHF 的患者。本研究共纳入 1150 例年龄≥65 岁的单纯髋部骨折患者。共检查了 3 个队列：（1）≥90 岁的患者；（2）65-89 岁的患者；（3）≥90 岁与 65-75 岁、≥90 岁与 75-89 岁的患者分层。然后根据手术时间（是否在≤24 小时内进行）将患者进一步分层。主要结局是住院死亡率。
延迟手术的 90 岁以上患者死亡率高于早期手术的患者（15.2%比 4.2%；02）。65-75 岁的患者延迟手术并发症发生率较高（12.9%比 4.1%；01），76-89 岁的患者也较高（9.0%比 3.2%，004）。
在 24 小时内对 90 岁以上的孤立性髋部骨折患者进行早期手术干预与良好的临床结局相关，且住院死亡率较低，接近显著水平。
