Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm; Function Perioperative Medicine and Intensive Care (PMI), Karolinska University Hospital, Stockholm.
Institute of Environmental Medicine (IMM), Karolinska Institutet, Stockholm.
Acta Orthop. 2023 Feb 27;94:87-96. doi: 10.2340/17453674.2023.9595.
Waiting time to surgery is a modifiable risk factor in hip fracture surgery. However, there is no consensus regarding the acceptable duration of waiting time. We used the Swedish Hip Fracture Register RIKSHÖFT and 3 administrative registers to explore the association between time to surgery and adverse outcomes after discharge.
63,998 patients ≥ 65 years, admitted to a hospital between January 1, 2012, and August 31, 2017 were included. Time to surgery was divided into < 12, 12-24, and > 24 hours. Diagnoses investigated were atrial fibrillation/flutter (AF), congestive heart failure (CHF), pneumonia, and "acute ischemia" (a combination of stroke/intracranial bleeding, myocardial infarction, and acute kidney injury). Crude and adjusted survival analyses were performed. Time spent in hospital following the initial hospitalization was described for the 3 groups.
Waiting > 24 hours was associated with an increased risk of AF (HR 1.4, 95%CI 1.2-1.6), CHF (HR 1.3, CI 1.1-1.4) and "acute ischemia" (HR 1.2, CI 1.01-1.3). However, stratifying for ASA grade revealed that these associations were present only in patients with ASA 3-4. There was no association between waiting time and pneumonia after the initial hospitalization (HR 1.1, CI 0.97-1.2), but one was found with pneumonia during hospital stay OR 1.2 (CI 1.1-1.4). Time in hospital after the initial hospitalization was similar over the waiting time groups.
The associations between waiting > 24 hours for hip fracture surgery and AF, CHF, and acute ischemia suggest that shorter waiting time may reduce adverse outcomes for the sicker patients.
手术等待时间是髋部骨折手术的一个可改变的风险因素。然而，对于可接受的等待时间长度，尚无共识。我们使用瑞典髋部骨折登记 RIKSHÖFT 和 3 个行政登记处，探讨了手术时间与出院后不良结局之间的关系。
共纳入了 63998 名年龄≥65 岁、于 2012 年 1 月 1 日至 2017 年 8 月 31 日期间住院的患者。手术时间分为<12 小时、12-24 小时和>24 小时。研究的诊断包括心房颤动/扑动（AF）、充血性心力衰竭（CHF）、肺炎和“急性缺血”（中风/颅内出血、心肌梗死和急性肾损伤的组合）。进行了粗死亡率和调整后生存率分析。还描述了 3 组患者在初次住院后的住院时间。
等待时间>24 小时与 AF（HR 1.4，95%CI 1.2-1.6）、CHF（HR 1.3，CI 1.1-1.4）和“急性缺血”（HR 1.2，CI 1.01-1.3）的风险增加相关。然而，对 ASA 分级进行分层后发现，这些相关性仅存在于 ASA 3-4 级的患者中。初次住院后等待时间与肺炎之间无关联（HR 1.1，CI 0.97-1.2），但在住院期间肺炎与肺炎之间存在关联 OR 1.2（CI 1.1-1.4）。初次住院后住院时间在等待时间组之间相似。
髋部骨折手术等待时间>24 小时与 AF、CHF 和急性缺血之间的关联表明，缩短等待时间可能会降低病情较重患者的不良结局。
