Forssten Maximilian Peter, Mohammad Ismail Ahmad, Ioannidis Ioannis, Ribeiro Marcelo A F, Cao Yang, Sarani Babak, Mohseni Shahin
Department of Orthopedic Surgery, Faculty of Medicine and Health, Orebro University, Orebro, Sweden.
School of Medical Sciences, Orebro University, Orebro, Sweden.
Front Surg. 2024 Mar 8;11:1367457. doi: 10.3389/fsurg.2024.1367457. eCollection 2024.
The number of patients with hip fractures continues to rise as the average age of the population increases. Optimizing outcomes in this cohort is predicated on timely operative repair. The aim of this study was to determine if patients with hip fractures who are frail or have a higher cardiac risk suffer from an increased risk of in-hospital mortality when surgery is postponed >24 h.
All patients registered in the 2013-2021 TQIP dataset who were ≥65 years old and underwent surgical fixation of an isolated hip fracture caused by a ground-level fall were included. Adjustment for confounding was performed using inverse probability weighting (IPW) while stratifying for frailty with the Orthopedic Frailty Score (OFS) and cardiac risk using the Revised Cardiac Risk Index (RCRI). The outcome was presented as the absolute risk difference in in-hospital mortality.
A total of 254,400 patients were included. After IPW, all confounders were balanced. A delay in surgery was associated with an increased risk of in-hospital mortality across all strata, and, as the degree of frailty and cardiac risk increased, so too did the risk of mortality. In patients with OFS ≥4, delaying surgery >24 h was associated with a 2.33 percentage point increase in the absolute mortality rate (95% CI: 0.57-4.09, = 0.010), resulting in a number needed to harm (NNH) of 43. Furthermore, the absolute risk of mortality increased by 4.65 percentage points in patients with RCRI ≥4 who had their surgery delayed >24 h (95% CI: 0.90-8.40, = 0.015), resulting in a NNH of 22. For patients with OFS 0 and RCRI 0, the corresponding NNHs when delaying surgery >24 h were 345 and 333, respectively.
Delaying surgery beyond 24 h from admission increases the risk of mortality for all geriatric hip fracture patients. The magnitude of the negative impact increases with the patient's level of cardiac risk and frailty. Operative intervention should not be delayed based on frailty or cardiac risk.
随着人口平均年龄的增长，髋部骨折患者的数量持续上升。在这一群体中优化治疗结果取决于及时进行手术修复。本研究的目的是确定身体虚弱或心脏风险较高的髋部骨折患者在手术推迟超过24小时时，院内死亡风险是否会增加。
纳入2013 - 2021年TQIP数据集中所有年龄≥65岁且因平地跌倒导致孤立性髋部骨折并接受手术固定的患者。使用逆概率加权法（IPW）进行混杂因素调整，同时用骨科虚弱评分（OFS）对虚弱程度进行分层，并用修订心脏风险指数（RCRI）对心脏风险进行分层。结果以院内死亡的绝对风险差异表示。
共纳入254,400例患者。经过IPW后，所有混杂因素达到平衡。手术延迟与所有分层中院内死亡风险增加相关，并且随着虚弱程度和心脏风险的增加，死亡风险也增加。在OFS≥4的患者中，手术延迟>24小时与绝对死亡率增加2.33个百分点相关（95%CI：0.57 - 4.09，P = 0.010），导致伤害所需人数（NNH）为43。此外，RCRI≥4且手术延迟>24小时的患者，绝对死亡风险增加4.65个百分点（95%CI：0.90 - 8.40，P = 0.015），导致NNH为22。对于OFS为0和RCRI为0的患者，手术延迟>24小时时相应的NNH分别为345和333。
入院后手术延迟超过24小时会增加所有老年髋部骨折患者的死亡风险。负面影响的程度随着患者的心脏风险水平和虚弱程度而增加。不应基于虚弱或心脏风险而延迟手术干预。
