Service d'orthopédie-traumatologie, CHU de Dupuytren, 2, avenue Martin Luther King, 87042 Limoges cedex, France.
Service d'orthopédie-traumatologie, CHU de Dupuytren, 2, avenue Martin Luther King, 87042 Limoges cedex, France.
Orthop Traumatol Surg Res. 2023 Dec;109(8):103707. doi: 10.1016/j.otsr.2023.103707. Epub 2023 Oct 13.
Hip fractures require surgical treatment within 48hours to decrease the risk of postoperative complications. Elliott proposed a prognostic score to identify which patients should be prioritized for surgery. This study was designed to answer the following questions: 1- Does using this score shorten the time to surgery? 2- Does shortening the time to surgery reduce mortality at 6 months and 1 year? 3- What factors delay the surgical procedure? We hypothesized that using this score as an educational tool would reduce the time to surgery in patients over 75 years of age who have a hip fracture.
This single-center study involved two populations: 244 patients were included prospectively who had the score applied with the aim of optimizing the time to surgery; 476 patients were included from a historical cohort to serve as a reference group.
The mean time to surgery was 2.5 days±1.9 [95% CI: 2.41-2.77] and the median was 2 days (minimum 0, maximum 18 days) in the reference group; the mean was 1.4 days±1.0 [95% CI: 1.46-1.67] and the median was 1 day (min. 0, max 6 days) in the prospective cohort, which was a significant reduction (p<0.001). At 6 months, the mortality rate was 22.5% in the reference population and 23% in the prospective cohort. At 1 year, the mortality rate was 47% and 46%, respectively, with no significant difference. Surgical delays were attributed to lack of OR availability, management of anticoagulants, request for cardiac ultrasound and administrative reasons.
DISCUSSION/CONCLUSION: Elliot's prognostic at-risk score for hip fracture can shorten the time to surgery when used an educational tool to raise the medical staff's awareness of the benefits of rapid surgical care.
IV; retrospective study without control group.
髋部骨折需要在 48 小时内进行手术治疗，以降低术后并发症的风险。Elliott 提出了一种预后评分系统，以确定哪些患者应优先接受手术。本研究旨在回答以下问题：1. 使用该评分是否能缩短手术时间？2. 缩短手术时间是否能降低 6 个月和 1 年的死亡率？3. 哪些因素会延迟手术？我们假设，将该评分作为一种教育工具，可缩短 75 岁以上髋部骨折患者的手术时间。
这是一项单中心研究，涉及两个人群：244 例患者前瞻性纳入，应用该评分以优化手术时间；476 例患者从历史队列中纳入作为对照组。
对照组的手术时间平均为 2.5 天±1.9 [95%可信区间：2.41-2.77]，中位数为 2 天（最短 0 天，最长 18 天）；前瞻性队列的手术时间平均为 1.4 天±1.0 [95%可信区间：1.46-1.67]，中位数为 1 天（最短 0 天，最长 6 天），差异有统计学意义（p<0.001）。6 个月时，对照组的死亡率为 22.5%，前瞻性队列为 23%。1 年时，死亡率分别为 47%和 46%，差异无统计学意义。手术延迟归因于缺乏手术室可用性、抗凝剂管理、心脏超声检查请求和行政原因。
讨论/结论：当使用教育工具提高医护人员对快速手术护理益处的认识时，Elliott 的髋部骨折风险预测评分可以缩短手术时间。
IV；无对照组的回顾性研究。
