Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, NO.87 Ding Jia Qiao, Nanjing, 210009, PR China.
Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, PR China.
Orthop Surg. 2023 May;15(5):1304-1311. doi: 10.1111/os.13741. Epub 2023 Apr 13.
Reports show an increase in the short-term mortality rates of hip fracture patients admitted on weekends. However, there are few studies on whether there is a similar effect in Friday admissions of geriatric hip fracture patients. The aim of this study was to evaluate the effects of Friday admission on mortality and clinical outcomes in elderly patients with hip fractures.
A retrospective cohort study was performed at a single orthopaedic trauma centre and included all patients who underwent hip fracture surgery between January 2018 and December 2021. Patient characteristics, including age, sex, BMI, fracture type, time of admission, ASA grade, comorbidities, and laboratory examinations, were collected. Data pertaining to surgery and hospitalization were extracted from the electronic medical record system and tabulated. The corresponding follow-up was performed. The Shapiro-Wilk test was applied to evaluate the distributions of all continuous variables for normality. The overall data were analyzed by Student's t test or the Mann-Whitney U test for continuous variables and the chi-square test for categorical variables, as appropriate. Univariate and multivariate analyses were used to further test for the independent influencing factors of prolonged time to surgery.
A total of 596 patients were included, and 83 patients (13.9%) were admitted on Friday. There was no evidence supporting that Friday admission had an effect on mortality and outcomes, including length of stay, total hospital costs and postoperative complications. However, the patients admitted on Friday had delayed surgery. Then, patients were regrouped into two groups according to whether surgery was delayed, and 317 patients (53.2%) underwent delayed surgery. The multivariate analysis showed that younger age (p = 0.014), Friday admission (p < 0.001), ASA classification III-IV (p = 0.019), femoral neck fracture (p = 0.002), time from injury to admission more than 24 h (p = 0.025), and diabetes (p = 0.023) were risk factors for delayed surgery.
Mortality and adverse outcome rates for elderly hip fracture patients admitted on Friday were similar to those admitted at other time periods. However, Friday admission was identified as one of the risk factors for delayed surgery.
有报道称，髋部骨折患者在周末入院的短期死亡率增加。然而，关于老年髋部骨折患者在周五入院是否存在类似影响的研究较少。本研究旨在评估周五入院对老年髋部骨折患者死亡率和临床结局的影响。
这是一项在一家骨科创伤中心进行的回顾性队列研究，纳入了 2018 年 1 月至 2021 年 12 月期间接受髋部骨折手术的所有患者。收集患者特征，包括年龄、性别、BMI、骨折类型、入院时间、ASA 分级、合并症和实验室检查。手术和住院数据从电子病历系统中提取并列表。进行相应的随访。应用 Shapiro-Wilk 检验评估所有连续变量的分布是否符合正态性。总体数据采用 Student's t 检验或 Mann-Whitney U 检验进行连续性变量分析，采用卡方检验进行分类变量分析，视情况而定。采用单因素和多因素分析进一步检验手术时间延长的独立影响因素。
共纳入 596 例患者，83 例（13.9%）患者在周五入院。没有证据表明周五入院对死亡率和结局有影响，包括住院时间、总住院费用和术后并发症。然而，周五入院的患者手术时间延迟。然后，根据手术是否延迟将患者分为两组，其中 317 例（53.2%）患者接受了延迟手术。多因素分析显示，年龄较小（p=0.014）、周五入院（p<0.001）、ASA 分级 III-IV（p=0.019）、股骨颈骨折（p=0.002）、受伤至入院时间超过 24 h（p=0.025）和糖尿病（p=0.023）是手术延迟的危险因素。
周五入院的老年髋部骨折患者的死亡率和不良结局发生率与其他时间段入院的患者相似。然而，周五入院被确定为手术延迟的危险因素之一。
