University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee.
University of Tennessee Medical Center Department of Surgery, Knoxville, Tennessee.
J Surg Res. 2024 Sep;301:704-708. doi: 10.1016/j.jss.2024.07.083. Epub 2024 Aug 20.
Fragility fractures occur due to low energy mechanisms and result in significant morbidity and mortality. This study reviews the implementation of a fragility fracture program at a level I trauma center. In this pathway, trauma surgery provides clearance followed by admission and management with medical service and orthopedic consultation for injuries which meet fragility fracture criteria.
This pathway, implemented in July 2021, includes patients with isolated fractures secondary to a low energy mechanism. We compared cohorts 2-ys before (PRE) and after (POS) pathway implementation. Demographics (age, sex, fracture location, injury severity score, American Society of Anesthesiologists score) and outcome data were collected and analyzed using between-subjects analyses. Measured outcomes included deep vein thrombosis/pulmonary embolism, hospital mortality, disposition to hospice, nonoperative rate, unplanned intensive care unit admission, time to surgery (TTS), and length of stay (LOS).
The study included n = 1137 patients (n = 564 PRE and n = 573 POS). POS patients had a higher injury severity score (P = 0.003) and different fracture location (P = 0.017), but no other demographics were different. Trauma admission decreased after implementation (P < 0.001; PRE: 21.5%, POS: 1.8%) with no differences in outcomes except increases in LOS (P < 0.001; PRE: 114 h, POS: 124 h) and TTS (P < 0.001; PRE: 15 h, POS: 18 h).
Morbidity and mortality did not correlate with pathway implementation; however, TTS and LOS increased. Although TTS increased, it remained under the American Academy of Orthopedic Surgery 48-h recommendation. The TTS and LOS increases were potentially from COVID-19 or cohort demographic differences. Decreased trauma as admitting service demonstrates pathway adherence. These findings highlight the need for investigation to better understand fragility fracture pathways.
脆性骨折是由低能量机制引起的，会导致严重的发病率和死亡率。本研究回顾了在一级创伤中心实施脆性骨折项目的情况。在这个途径中，创伤外科提供清除术，然后由医疗服务和骨科咨询来管理符合脆性骨折标准的损伤。
该途径于 2021 年 7 月实施，包括因低能量机制导致的孤立性骨折的患者。我们比较了途径实施前（PRE）和后（POS）的两个队列。收集并使用受试者间分析方法分析了人口统计学数据（年龄、性别、骨折部位、损伤严重程度评分、美国麻醉医师协会评分）和结果数据。测量的结果包括深静脉血栓形成/肺栓塞、院内死亡率、临终关怀机构的安置、非手术率、非计划转入重症监护病房、手术时间（TTS）和住院时间（LOS）。
该研究共纳入 1137 名患者（n=564 PRE 和 n=573 POS）。POS 患者的损伤严重程度评分较高（P=0.003）和骨折部位不同（P=0.017），但其他人口统计学数据没有差异。实施后创伤入院率下降（P<0.001；PRE：21.5%，POS：1.8%），除 LOS（P<0.001；PRE：114 h，POS：124 h）和 TTS（P<0.001；PRE：15 h，POS：18 h）外，其他结果无差异。
发病率和死亡率与途径的实施无关，但 TTS 和 LOS 增加。尽管 TTS 增加，但仍低于美国矫形外科医师协会的 48 小时建议。TTS 和 LOS 的增加可能是由于 COVID-19 或队列人口统计学差异造成的。作为主要的治疗科室，创伤外科的就诊率下降表明该途径得到了执行。这些发现强调了需要进行调查以更好地了解脆性骨折途径。
