Allahabadi Sachin, Roostan Mohammad, Roddy Erika, Ward Derek T, Rogers Stephanie, Kim Candace
Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA, USA.
Department of Internal Medicine, Division of Geriatrics, University of California San Francisco, San Francisco, CA, USA.
Geriatr Orthop Surg Rehabil. 2022 Aug 17;13:21514593221116331. doi: 10.1177/21514593221116331. eCollection 2022.
Morbidity and mortality benefits have been associated with prompt surgical treatment of geriatric hip fractures. The purpose of this study was to evaluate the impact of early (≤24 hr) vs delayed (>24 hr) time to operating room (TTOR) on 1) hospital length of stay and 2) total and post-operative opiate use in geriatric hip fractures.
This study was a retrospective review of patients ≥65 years-old at the time of admission for surgery for hip fracture at a Level II academic trauma center. Outcome measures were length of stay (LOS), oral morphine equivalents (OME) throughout hospitalization. Patients were stratified into early and delayed TTOR groups and comparisons were made between groups.
Between the early (n = 75, 80.6%) and late (n = 18, 19.4%) groups, there were no differences in age, fracture pattern, type of treatment, preoperative opiate use, and perioperative non-oral pain management. The early group trended toward shorter total LOS (108.0 ± 67.2 hours vs 144.8 ± 103.7 hours, = .066), but not post-operative LOS. Total OME usage was less in the early intervention group (92.5 ± 188.0 vs 230.2 ± 296.7, = .015), in addition to reduced post-operative OME (81.3 ± 174.9 vs 213.3 ± 271.3, = .012). There were no differences in evaluated potential delay sources such as primary language, use of surrogate decision makers, or need for advanced imaging.
Surgical treatment of geriatric hip/femur fractures in ≤24 hours from presentation is achievable and may be associated with reduced total inpatient opiate use, although daily use did not differ.
Establishing institutional TTOR goals as part of an interdisciplinary hip fracture co-management clinical pathway can facilitate prompt care and contribute to recovery and less opiate use in these patients with highly morbid injuries.
老年髋部骨折的及时手术治疗与发病率和死亡率的改善相关。本研究的目的是评估早期（≤24小时）与延迟（>24小时）进入手术室时间（TTOR）对1）老年髋部骨折患者的住院时间和2）阿片类药物的总使用量及术后使用量的影响。
本研究是对一家二级学术创伤中心因髋部骨折入院接受手术时年龄≥65岁的患者进行的回顾性研究。观察指标为住院时间（LOS）、住院期间口服吗啡当量（OME）。患者被分为早期和延迟TTOR组，并对两组进行比较。
在早期组（n = 75，80.6%）和晚期组（n = 18，19.4%）之间，年龄、骨折类型、治疗方式、术前阿片类药物使用情况和围手术期非口服疼痛管理方面无差异。早期组的总住院时间有缩短趋势（108.0±67.2小时 vs 144.8±103.7小时，P = 0.066），但术后住院时间无差异。早期干预组的总OME使用量较少（92.5±188.0 vs 230.2±296.7，P = 0.015），术后OME也减少（81.3±174.9 vs 213.3±271.3，P = 0.012）。在评估的潜在延迟来源方面，如主要语言、使用替代决策者或是否需要高级影像学检查，两组之间无差异。
老年髋部/股骨骨折在就诊后≤24小时内进行手术治疗是可行的，并且可能与住院期间阿片类药物总使用量减少有关，尽管每日使用量无差异。
将机构TTOR目标作为跨学科髋部骨折联合管理临床路径的一部分来设定，可以促进及时治疗，并有助于这些重伤患者的康复和减少阿片类药物的使用。
