Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
Department of Orthopaedic Surgery, National Centre for Geriatrics and Gerontology, Obu, Aichi, Japan.
Hip Int. 2024 Sep;34(5):660-667. doi: 10.1177/11207000241248836. Epub 2024 May 21.
Early surgery for hip fracture, within 48 hours of hospital admission, is effective in reducing mortality. However, the average preoperative waiting time for hip fractures in Japan is 4.5 days and the 1-year mortality rate after a hip fracture is 10% in Japan. This study aimed to investigate whether early surgery, within 48 hours, could reduce the 1-year mortality rate in patients with hip fractures in Japan.
This cohort study involved 402 consecutive patients with hip fractures who underwent surgical treatment between January 2013 and September 2019. The exclusion criteria were an age of <60 years and in-hospital injury. A total of 389 patients were included in this study. The patients were divided into two groups: those who underwent early surgery within 48 hours of admission (early group) and those who di not undergo early surgery (delayed group). We compared patient characteristics and treatment outcomes between the 2 groups.
A comparison of patient characteristics revealed that the early group had lower hemoglobin levels (P=0.046), lower C-reactive protein levels ( = 0.031), lower numbers of patients with weekend hospitalization, lower numbers of patients with a history of using medications that may cause bleeding ( < 0.01), and who received general anaesthesia ( < 0.01). However, there were no significant differences with regard to the other variables between the 2 groups. A treatment outcome analysis showed that the early group had shorter waiting times for surgery ( < 0.01) and shorter stays in acute-care wards ( < 0.01). However there were no differences in the total hospital stay, Barthel index at discharge, home discharge rates, in-hospital mortality rates, and 1-year mortality.
Our findings indicate that early surgery did not reduce the 1-year mortality rate in older patients with hip fractures in Japan.
髋部骨折患者在入院后 48 小时内进行早期手术可有效降低死亡率。然而，日本髋部骨折患者的平均术前等待时间为 4.5 天，日本髋部骨折后 1 年的死亡率为 10%。本研究旨在探讨日本髋部骨折患者是否能通过早期手术（48 小时内）降低 1 年死亡率。
本队列研究纳入了 2013 年 1 月至 2019 年 9 月期间接受手术治疗的 402 例连续髋部骨折患者。排除标准为年龄<60 岁和院内损伤。共有 389 例患者纳入本研究。将患者分为两组：入院后 48 小时内行早期手术的患者（早期组）和未行早期手术的患者（延迟组）。比较两组患者的一般资料和治疗结局。
两组患者的一般资料比较显示，早期组的血红蛋白水平较低（P=0.046）、C 反应蛋白水平较低（ = 0.031）、周末入院的患者较少、有使用可能引起出血的药物史的患者较少（ < 0.01）、接受全身麻醉的患者较少（ < 0.01）。但两组间其他变量无显著差异。治疗结局分析显示，早期组的手术等待时间较短（ < 0.01）、急性病房住院时间较短（ < 0.01）。但总住院时间、出院时 Barthel 指数、出院回家率、院内死亡率和 1 年死亡率无差异。
我们的研究结果表明，早期手术并未降低日本老年髋部骨折患者的 1 年死亡率。
