Yamada Yutoku, Kotani Toshiaki, Kishida Shunji, Ogata Yosuke, Okuwaki Shun, Ohyama Shuhei, Iwata Shuhei, Iijima Yasushi, Ise Shohei, Sakuma Tsuyoshi, Ueno Keisuke, Kajiwara Daisuke, Moriyasu Risa, Nakajima Takako, Minami Shohei, Hashimoto Eiko, Ochiai Nobuyasu, Ohtori Seiji
Department of Orthopeadic Surgery, Seirei Sakura Citizen Hospital, Chiba, Japan; Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
Department of Orthopeadic Surgery, Seirei Sakura Citizen Hospital, Chiba, Japan.
J Orthop Sci. 2025 May;30(3):518-522. doi: 10.1016/j.jos.2024.08.001. Epub 2024 Aug 26.
Proximal femoral fractures in geriatric patients are a major challenge in orthopedics, often leading to major functional impairment. Early surgical intervention is crucial for improving patient recovery and overall health outcomes. Thus, Japan's Ministry of Health, Labour and Welfare initiated a reimbursement policy in April 2022 to encourage early surgery for these fractures in patients aged ≥75 years. This study investigated the impact of this policy on early surgery rates in Japan and identified factors influencing the timing of surgical interventions.
We retrospectively analyzed the data of patients who underwent surgery for proximal femoral fractures at our institution between April 2022 and March 2023. Patients were categorized into two groups based on the timing of surgery relative to the injury: ≤48 h and >48 h. Demographic and clinical data, including age, sex, fracture type, and various health- and admission-related factors, were assessed.
Of the 192 patients, 152 were included in the study. Among them, 38% underwent early surgery (≤48 h), and 15% of the patients arrived more than 48 h post-injury. Significant differences were found in admission routes and residence types between the groups. The ≤48 h group had shorter intervals from injury to admission and surgery than the >48 h group. Factors such as the admission process, day of the week, and C-reactive protein levels significantly influenced the timing of surgery.
After introducing incentives for early surgery in Japan, 38% of patients with proximal femoral fractures underwent surgery within 48 h of injury. Factors contributing to patients not receiving early surgery included transport from another hospital, weekend hospitalization, and elevated CRP levels. These findings suggest that achieving surgery within 48 h of injury is challenging through hospital efforts alone, and the time criteria might be more appropriate if changed to "admission to surgery."
老年患者股骨近端骨折是骨科领域的一项重大挑战，常导致严重的功能障碍。早期手术干预对于改善患者康复情况和整体健康结局至关重要。因此，日本厚生劳动省于2022年4月启动了一项报销政策，以鼓励对75岁及以上的此类骨折患者进行早期手术。本研究调查了该政策对日本早期手术率的影响，并确定了影响手术干预时机的因素。
我们回顾性分析了2022年4月至2023年3月期间在我院接受股骨近端骨折手术的患者数据。根据手术时间与受伤时间的关系，将患者分为两组：≤48小时组和>48小时组。评估了人口统计学和临床数据，包括年龄、性别、骨折类型以及各种与健康和入院相关的因素。
192例患者中，152例纳入研究。其中，38%的患者接受了早期手术（≤48小时），15%的患者在受伤后48小时以上才就诊。两组在入院途径和居住类型方面存在显著差异。≤48小时组从受伤到入院和手术的间隔时间比>48小时组短。入院流程、星期几和C反应蛋白水平等因素对手术时机有显著影响。
在日本引入早期手术激励措施后，38%的股骨近端骨折患者在受伤后48小时内接受了手术。导致患者未接受早期手术的因素包括从其他医院转运、周末住院以及CRP水平升高。这些发现表明，仅靠医院的努力在受伤后48小时内实现手术具有挑战性，如果将时间标准改为“入院到手术”可能会更合适。
