Department of Orthopaedics Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.
Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.
PLoS One. 2024 Jul 31;19(7):e0282766. doi: 10.1371/journal.pone.0282766. eCollection 2024.
Hip fracture is a common injury in older adults; however, the optimal timing of surgical treatment remains undetermined in Japan. Therefore, this retrospective study aimed to ascertain the rate of early surgery among hip fracture patients and investigate its effectiveness, along with "regional clinical pathways" (patient plan of care devised by Japanese clinicians), in reducing the length of hospital stay (LOS) postoperatively. We hypothesized that performing early surgery along with a regional clinical pathway is effective to reduce the postoperative LOS and complications among hip fracture patients. We examined the data of patients diagnosed with femoral neck and peritrochanteric fractures retrieved from the Japanese Diagnosis Procedure Combination database between April 2016 and March 2018. Patients were divided into the early (43,928, 34%; surgery within 2 days of admission) and delayed (84,237, 66%; surgery after 2 days of admission) surgery groups. The difference in postoperative LOS between the two groups was 3 days (early vs. delayed: 29 days vs. 32 days). The early surgery group had more cases of intertrochanteric fractures (57% vs. 43%) and internal fixation (74% vs. 55%) than did the delayed surgery group. In contrast, the delayed surgery group had more cases of femoral neck fractures (43% vs. 57%) and bipolar hip arthroplasty (25% vs. 42%) or total hip arthroplasty (1.2% vs. 3.0%). Moreover, the early surgery group showed a lower incidence of complications, except anemia (12% vs. 8.8%). Logistic regression analysis using the adjusted model revealed that early surgery and implementation of regional clinical pathways reduced LOS by 2.58 and 8.06 days, respectively (p<0.001). Early surgery and implementation of regional clinical pathways for hip fracture patients are effective in reducing postoperative LOS, allowing regional clinical pathways to have a greater impact. These findings will help acute care providers when treating hip fracture patients.
髋部骨折是老年人常见的损伤；然而，在日本，手术治疗的最佳时机仍未确定。因此，本回顾性研究旨在确定髋部骨折患者早期手术的比例，并调查其有效性，以及“区域临床路径”（日本临床医生制定的患者护理计划）在缩短术后住院时间（LOS）方面的作用。我们假设，早期手术和区域临床路径的联合应用可以有效降低髋部骨折患者的术后 LOS 和并发症发生率。我们检查了 2016 年 4 月至 2018 年 3 月期间从日本诊断程序组合数据库中检索到的诊断为股骨颈和转子间骨折患者的数据。患者分为早期（43928 例，34%；入院后 2 天内手术）和延迟（84237 例，66%；入院后 2 天以上手术）手术组。两组患者术后 LOS 差异为 3 天（早期 vs. 延迟：29 天 vs. 32 天）。早期手术组的转子间骨折（57% vs. 43%）和内固定（74% vs. 55%）比例高于延迟手术组。相反，延迟手术组的股骨颈骨折（43% vs. 57%）和双极髋关节置换术（25% vs. 42%）或全髋关节置换术（1.2% vs. 3.0%）比例更高。此外，除贫血（12% vs. 8.8%）外，早期手术组并发症发生率较低。使用调整后的模型进行逻辑回归分析显示，早期手术和区域临床路径的实施分别使 LOS 减少 2.58 和 8.06 天（p<0.001）。对于髋部骨折患者，早期手术和区域临床路径的实施可有效缩短术后 LOS，区域临床路径的影响更大。这些发现将有助于急性护理提供者在治疗髋部骨折患者时做出决策。
