Meyer Jacob R, Earnest Ryan E, Johnson Brian M, Steffensmeier Andrew M, Vyas Dheer A, Laughlin Richard T
Department of Orthopaedic Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
Geriatr Orthop Surg Rehabil. 2023 Jun 8;14:21514593231181991. doi: 10.1177/21514593231181991. eCollection 2023.
Hip fractures are common among the elderly, and delays in time to surgery (TTS) and length of stay (LOS) are known to increase mortality risk in these patients. Preoperative multidisciplinary protocols for hip fracture management are effective at larger trauma hospitals. The purpose of this study is to evaluate the effect of a similar multidisciplinary preoperative protocol for geriatric hip fracture patients at our Level III trauma center.
In this single-center retrospective study, patients aged 65 and older who were admitted from March 2016 to December 2018 (pre-protocol group, Cohort #1, n = 247) and from August 2021 to September 2022 (post-protocol group, Cohort #2, n = 169) were included. Demographic information, TTS, and LOS were obtained and compared using Student's -test and Chi-square testing.
There was a significant decrease in TTS in Cohort #2 compared to Cohort #1 ( < .001). There was a significant increase in LOS in Cohort #2 compared to Cohort #1 ( < .05), but when comparing a subset of Cohort #2 (Subgroup 2B, patients admitted from May to September 2022 when the effects of COVID-19 were likely dissipated) to Cohort #1, there was no significant difference in LOS ( = .13). For patients admitted to skilled nursing facilities (SNF), LOS in Cohort #2 was significantly longer than in Cohort #1 ( = .001).
In general, Level III hospitals have fewer perioperative resources compared to larger Level I hospitals. Despite this fact, this multidisciplinary preoperative protocol effectively reduced TTS which improves mortality risk in elderly patients. LOS is a multifactorial variable, and we believe the COVID-19 pandemic was a significant confounder that reduced available SNF beds in our area which prolonged the average LOS in Cohort #2.
A multidisciplinary preoperative protocol for geriatric hip fracture management can improve efficiency of getting patients to surgery at Level III trauma centers.
髋部骨折在老年人中很常见，已知手术时间延迟（TTS）和住院时间（LOS）会增加这些患者的死亡风险。在大型创伤医院，术前多学科髋部骨折管理方案是有效的。本研究的目的是评估在我们的三级创伤中心，类似的多学科术前方案对老年髋部骨折患者的效果。
在这项单中心回顾性研究中，纳入了2016年3月至2018年12月入院的65岁及以上患者（术前方案组，队列#1，n = 247）以及2021年8月至2022年9月入院的患者（术后方案组，队列#2，n = 169）。获取人口统计学信息、TTS和LOS，并使用学生t检验和卡方检验进行比较。
与队列#1相比，队列#2的TTS显著降低（P <.001）。与队列#1相比，队列#2的LOS显著增加（P <.05），但将队列#2的一个子集（亚组2B，2022年5月至9月入院的患者，此时新冠疫情的影响可能已消散）与队列#1进行比较时，LOS没有显著差异（P =.13）。对于入住专业护理机构（SNF）的患者，队列#2的LOS显著长于队列#1（P =.001）。
一般来说，与大型一级医院相比，三级医院的围手术期资源较少。尽管如此，这种多学科术前方案有效地缩短了TTS，从而降低了老年患者的死亡风险。LOS是一个多因素变量，我们认为新冠疫情是一个重要的混杂因素，它减少了我们地区可用的SNF床位，从而延长了队列#2的平均LOS。
老年髋部骨折管理的多学科术前方案可以提高三级创伤中心患者的手术效率。
