Jabbouri Sahir S, Yang Ally A, Joo Peter, Elaydi Ali, Moore Anne, Riedel Matthew D, Bernstein Jenna
Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, USA.
Orthopaedics and Rehabilitation, Yale New Haven Hospital, New Haven, USA.
Cureus. 2024 Aug 14;16(8):e66886. doi: 10.7759/cureus.66886. eCollection 2024 Aug.
Introduction This study evaluates the effectiveness of a comprehensive hip fracture protocol, with a focus on specific readmission reasons. Methods A retrospective cohort study of hip fracture patients aged 60 and older who underwent surgery before (control) and after (intervention) implementation of a comprehensive hip fracture program. Objectives included identifying readmission reasons and rates, time to operating room (TOR), length of stay (LOS), reoperation, and mortality rates. Logistic regression was utilized to determine significance. Results One hundred and sixty-three patients (control) vs. 238 patients (intervention) were identified. The intervention group had higher odds of 90-day readmission for a medical reason (OR = 1.735, p = 0.028). Thirty-three out of forty-two patients (79%) in the control group and 68/78 patients (87%) in the intervention group were readmitted secondary to a medical reason (pulmonary etiology being the most common). Surgical-related readmissions (surgical site infections and dislocations are most common) were lower in the intervention group compared with the control group, with 10/78 patients (13%) and 9/42 patients (21%), respectively. Twenty-four-hour TOR was achieved in 125 patients (52.5%) in the intervention group vs. 70 patients (42.9%) in the control group. LOS was shorter by 1.1 days for the intervention group (p = 0.010). Mortality was lower in the intervention group. Discussion A comprehensive hip fracture protocol can reduce LOS, TOR, mortality rate, and even surgical-related readmissions. Readmission rates are mainly due to medical problems, which may be unavoidable and thus may not be an adequate hip fracture effectiveness metric. Potential areas of improvement and additional study may include closer internal medicine oversight and primary care follow-up after discharge.
引言 本研究评估了一项全面的髋部骨折治疗方案的有效性，重点关注特定的再入院原因。方法 对60岁及以上接受手术的髋部骨折患者进行回顾性队列研究，分为在全面髋部骨折治疗方案实施前（对照组）和实施后（干预组）。目标包括确定再入院原因和率、手术室时间（TOR）、住院时间（LOS）、再次手术和死亡率。采用逻辑回归确定显著性。结果 确定了163例患者（对照组）与238例患者（干预组）。干预组因医疗原因90天再入院的几率更高（OR = 1.735，p = 0.028）。对照组42例患者中有33例（79%），干预组78例患者中有68例（87%）因医疗原因（肺部病因最常见）再次入院。干预组与对照组相比，与手术相关的再入院率（手术部位感染和脱位最常见）较低，分别为78例患者中的10例（13%）和42例患者中的9例（21%）。干预组125例患者（52.5%）实现了24小时TOR，而对照组为70例患者（42.9%）。干预组的住院时间缩短了1.1天（p = 0.010）。干预组的死亡率较低。讨论 全面的髋部骨折治疗方案可以缩短住院时间、手术室时间、降低死亡率，甚至减少与手术相关的再入院率。再入院率主要是由于医疗问题，这可能是不可避免的，因此可能不是评估髋部骨折治疗效果的充分指标。潜在的改进领域和进一步研究可能包括出院后加强内科监督和初级保健随访。
