Department of Trauma and Orthopaedics, St Vincents University Hospital Elm Park, Dublin 4, Ireland.
Department of Geriatric and Stroke Medicine, Saolta Hospital Group, Galway University Hospital, Newcastle Road, Galway, Ireland.
Surgeon. 2024 Feb;22(1):25-30. doi: 10.1016/j.surge.2023.06.007. Epub 2023 Jul 28.
Hip fractures are increasing in incidence due to increasing life expectancy. Mortality continues to improve but it is important to explore which factors are responsible for driving improvements.
A cohort of hip fracture patients predating SARS-CoV-2 was examined to determine the predictors of adherence to the six Irish Hip Fracture Standards (IHFS) and the impact of adherence on short (30 day) and long term (1 year) mortality. Our primary aim was assess the impact of a single HFS and cumulative number of HFS on mortality after hip fracture. Our secondary aim was to determine the impact of the HFS which are intrinsically linked to specialist Geriatric care.
Across 962 patients, over 5 years, the factors which were associated with adherence to HFS were female gender, increasing ASA grade and being nursed on an orthopaedic ward. Patients with increasing ASA were more likely to have met HFS 4-6 (Geriatrician review HFS4, bone health HFS5 & specialist falls assessment HFS6), less likely to have surgery within 48 h are more likely to develop a pressure ulcer. If the patient was not nursed on an orthopaedic ward all HFS were less likely to be met. At 30 days HFS 4-6 were associated with a statistically significant odds ratio (OR) of being alive, while at one year HFS 1 (admitted to an orthopaedic ward within 4 h), 5 and 6 were associated with a statistically significant OR of being alive. As increasing numbers of hip fracture standards were met patients were more likely to be alive at 30 days and one year.
This study has identified that improved adherence to hip fracture standards are associated with improved mortality at 30 days and one year.
由于预期寿命的延长，髋部骨折的发病率不断增加。死亡率仍在不断提高，但重要的是要探讨哪些因素是导致死亡率提高的原因。
本研究检查了一组髋部骨折患者，这些患者发生在 SARS-CoV-2 之前，以确定遵守六个爱尔兰髋部骨折标准（IHFS）的预测因素，以及遵守这些标准对短期（30 天）和长期（1 年）死亡率的影响。我们的主要目的是评估单个 IHFS 和 IHFS 的累积数量对髋部骨折后死亡率的影响。我们的次要目的是确定与老年病专科护理密切相关的 IHFS 的影响。
在 962 名患者中，在 5 年的时间里，与遵守 IHFS 相关的因素是女性、ASA 评分增加和在矫形病房接受护理。ASA 评分增加的患者更有可能符合 IHFS 4-6（老年病医生审查 IHFS4、骨骼健康 IHFS5 和专科跌倒评估 IHFS6），不太可能在 48 小时内接受手术，更有可能发生压疮。如果患者不在矫形病房接受护理，则不太可能符合所有 IHFS。在 30 天时，IHFS 4-6 与存活的统计学显著优势比（OR）相关，而在 1 年时，IHFS 1（在 4 小时内入住矫形病房）、IHFS 5 和 IHFS 6 与存活的统计学显著 OR 相关。随着髋部骨折标准数量的增加，患者在 30 天和 1 年时存活的可能性更大。
本研究表明，髋部骨折标准的遵守情况得到改善与 30 天和 1 年的死亡率降低有关。
