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哥伦比亚老年髋部骨折卓越中心的经验:手术时间对住院死亡率和并发症的影响。

Experience of a centre of excellence in hip fractures of the elderly in Colombia: influence of time-to-surgery on inpatient mortality and complications.

机构信息

Department of orthopaedics and traumatology, University of La Sabana Clinic, Chía, Colombia.

Faculty of medicine, University La Sabana, Chía, Colombia.

出版信息

Int Orthop. 2024 Oct;48(10):2499-2504. doi: 10.1007/s00264-024-06249-7. Epub 2024 Aug 7.

DOI:10.1007/s00264-024-06249-7
PMID:39107627
Abstract

PURPOSE

To analyse the time-to-surgery of a centre of excellence in hip fractures of the elderly and its influence on inpatient mortality and postoperative complications.

METHODS

A cross-sectional cohort study was conducted. The sample universe consisted of 4,364 patients admitted to a university clinic in Chía, Colombia during the year 2018 to 2023 with ICD-10 diagnoses corresponding to femur fractures. After eliminating duplicates and application of inclusion and exclusion criteria, the final sample included was 269 patients. Qualitative and quantitative variables were analysed, such as: sex, age, age group, type of fracture, type of surgical procedure, time-to-surgery, time to discharge, inpatient mortality and postoperative complications.

RESULTS

The mean time-to-surgery from admission was 70.16 h or 2.92 days (IQR 37-87). Patients were divided into three subgroups of time in which they were taken to surgery: <24 h (11.89%), 24-48 h (33.82%) and > 48 h (54.27%). The overall mortality rate was 1.85% for a total of five deceased patients, two of whom belonged to the 24-48-hour group and three to the > 48 h group. Higher rates of postoperative complications were observed in the > 48-hours group (n: 39, 14.49%), followed by the 24-48-hour group (n: 25, 9.29%) and the < 24-hour group (n: 7, 2.6%).

CONCLUSIONS

Patients operated for a hip fracture in > 48 h since admission had a slightly higher rate of postoperative complications. No significant difference was observed regarding inpatient mortality when compared to the 24-48-hour group.

摘要

目的

分析一家老年髋部骨折治疗中心的手术时间及其对住院患者死亡率和术后并发症的影响。

方法

进行了一项横断面队列研究。样本总体包括 2018 年至 2023 年期间在哥伦比亚 Chía 的一所大学诊所住院的 4364 名患有 ICD-10 诊断为股骨骨折的患者。在消除重复项并应用纳入和排除标准后,最终纳入的样本量为 269 名患者。分析了定性和定量变量,如:性别、年龄、年龄组、骨折类型、手术类型、手术时间、出院时间、住院患者死亡率和术后并发症。

结果

从入院到手术的平均时间为 70.16 小时或 2.92 天(IQR 37-87)。患者被分为三个手术时间亚组:<24 小时(11.89%)、24-48 小时(33.82%)和>48 小时(54.27%)。总的死亡率为 1.85%,共有 5 名死亡患者,其中 2 名属于 24-48 小时组,3 名属于>48 小时组。>48 小时组术后并发症发生率较高(n:39,14.49%),其次是 24-48 小时组(n:25,9.29%)和<24 小时组(n:7,2.6%)。

结论

入院后>48 小时接受髋部骨折手术的患者术后并发症发生率略高。与 24-48 小时组相比,住院患者死亡率无显著差异。

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本文引用的文献

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Effects of Delayed Hip Fracture Surgery on Severely Ill Patients: Defining the Time to Medical Optimization.延迟髋部骨折手术对重症患者的影响:定义医疗优化的时间。
Am Surg. 2023 May;89(5):1864-1871. doi: 10.1177/00031348221080425. Epub 2022 Mar 24.
2
Evaluation of centers of excellence program for knee and hip replacement.卓越中心计划在膝关节和髋关节置换方面的评估。
Med Care. 2013 Jan;51(1):28-36. doi: 10.1097/MLR.0b013e3182699407.
3
A comprehensive hip fracture program reduces complication rates and mortality.一个全面的髋部骨折治疗方案可降低并发症发生率和死亡率。
J Am Geriatr Soc. 2008 Oct;56(10):1831-8. doi: 10.1111/j.1532-5415.2008.01945.x.