López-Martín Néstor, Escalera-Alonso Javier, Thuissard-Vasallo Israel John, Andreu-Vázquez Cristina, Bielza-Galindo Rafael
Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España.
Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España.
Rev Esp Geriatr Gerontol. 2023 Mar-Apr;58(2):61-67. doi: 10.1016/j.regg.2023.01.004. Epub 2023 Feb 16.
Orthogeriatric management with clinical pathways (CP) in hip fracture (HF) has been shown to be superior to other models. We studied whether updating the CP, through prioritization of admission and surgery, improvement in the prevention and treatment of delirium, management of anticoagulants and antiplatelet agents and the use of perioperative peripheral nerve block, modifies surgical delay, stay, readmissions, mortality, suffering delirium and functional status at discharge.
A retrospective observational study of unicenter cohorts of 468 patients with HF, 220 from 2016 (old VC) and 248 from 2019 (new VC). The variables are: intervention in the first 48hours, surgical delay (hours), stay (days), stay less than 15 days, delirium, functional loss at discharge (Barthel prefracture scale less Barthel scale at discharge), readmission at one month, and mortality at admission, month and year.
Median age: 87.0 [interquartile range 8.0], mostly women (76.7%). Significantly, with the new VC, there was a greater number of patients operated on in the first 48hours (27,7% vs 36,8% p=0.036), less surgical delay (72.5 [47,5-110,5] vs 64.0 [42,0-88,0] p<0.001), shorter stay (10,0 [7,0-13,0] vs 8,0 [6,0-11,0] p<0.001), greater number of discharges in 15 days (78,2% vs 91,5% p<0.001), lower delirium (54,1% vs 43,5% p=0.023). No significant changes in readmissions, functional loss at discharge, mortality at admission, 3 months or year.
Updating the VC brings benefits to the patient (less surgical delay, equal functional status at discharge with fewer days of admission) and benefits in management (lower admission) without modifying mortality.
已有研究表明，采用临床路径（CP）对髋部骨折（HF）进行骨科老年病管理优于其他模式。我们研究了通过优化入院和手术优先级、改善谵妄的预防与治疗、抗凝剂和抗血小板药物的管理以及围手术期外周神经阻滞的使用来更新临床路径，是否会改变手术延迟、住院时间、再入院率、死亡率、发生谵妄的情况以及出院时的功能状态。
对468例髋部骨折患者的单中心队列进行回顾性观察研究，其中2016年的220例（旧VC组），2019年的248例（新VC组）。观察变量包括：48小时内的干预情况、手术延迟（小时）、住院时间（天）、住院时间少于15天、谵妄、出院时的功能丧失（骨折前Barthel量表得分减去出院时Barthel量表得分）、1个月时的再入院情况以及入院时、3个月和1年时的死亡率。
中位年龄：87.0[四分位间距8.0]，大多数为女性（76.7%）。显著的是，采用新的临床路径后，48小时内接受手术的患者数量更多（27.7%对36.8%，p = 0.036），手术延迟更短（72.5[47.5 - 110.5]对64.0[42.0 - 88.0]，p < 0.001），住院时间更短（10.0[7.0 - 13.0]对8.0[6.0 - 11.0]，p < 0.001），15天内出院的患者数量更多（78.2%对91.5%，p < 0.001），谵妄发生率更低（54.1%对43.5%，p = 0.023）。再入院率、出院时的功能丧失、入院时、3个月或1年时的死亡率无显著变化。
更新临床路径给患者带来了益处（手术延迟更短、出院时功能状态相同但住院天数减少），并且在管理方面也有益处（入院率降低），同时不改变死亡率。
