Traumatology Vistahermosa, HLA Vistahermosa Clinic, Alicante, Spain.
Traumatology Vistahermosa, HLA Vistahermosa Clinic, Alicante, Spain.
Injury. 2024 Oct;55 Suppl 5:111653. doi: 10.1016/j.injury.2024.111653.
The aim of this study was to investigate the effect of time to surgery (TTS) on 30-day mortality in a cohort of patients from the Spanish National Hip Fracture Registry (SNHFR).
Retrospective study of a prospective database of hip fracture patients ≥ 75 years old between 2017 and 2019. Exclusion criterion was nonsurgical treatment. Association between TTS and 30-day mortality was assessed with a univariate analysis. Effect size was calculated using the probability of superiority. Regression analysis was performed to analyze the relationship between TTS and 30-day vital status. The ROC curve was used to evaluate the discrimination of mortality based on TTS.
A total of 29,695 patients met the inclusion criteria. The median TTS was 53.8 h. Surgery within 48 h was performed in 51.8 % of cases. Patients with delay of surgery more than 2 days rather than within 2 days were more likely to present an ASA score above 2 (58.9 % vs. 41.1 %, p < 0.001), less likely to achieve postoperative mobilization within 24 h (63 % vs. 67.4 %, p < 0.001), more likely to develop pressure ulcers (10.7 % vs. 6.9 %, p < 0.001), and had longer length of stay (10.7 days vs. 6.9 days, p < 0.001). The overall 30-day mortality rate was 7.8 %. Median TTS was significantly higher in decedents (66 h) than in survivors (56.5 h). There were higher statistically significant differences in 30-day mortality between patients who underwent surgery after 2 days (7.5 %) and those who underwent surgery within 2 days (5.4 %). The 30-day mortality was 5.2 % in patients operated within 24 h and 9.2 % in patients operated more than 120 h. Probability of superiority value was 0.44. Area under the curve reached a value of 0.55.
The associations between TTS and 30-day mortality were weak. Hip fracture surgery performed within 2 days was significantly associated with remobilization on the day after the hip fracture, with fewer postoperative pressure ulcers and shorter hospital stays. Despite the weakness of the TTS and 30-day mortality association, there are benefits to consider if surgery is performed within 2 days. Our results suggest that patients should be fit for surgery as soon as possible.
IV.
本研究旨在通过对西班牙国家髋关节骨折登记处（SNHFR）的患者队列进行研究，探讨手术时间（TTS）对 30 天死亡率的影响。
对 2017 年至 2019 年期间≥75 岁髋关节骨折患者的前瞻性数据库进行回顾性研究。排除标准为非手术治疗。使用单变量分析评估 TTS 与 30 天死亡率之间的关联。使用优势概率计算效应大小。进行回归分析以分析 TTS 与 30 天生命状态之间的关系。使用 ROC 曲线评估基于 TTS 的死亡率的区分能力。
共纳入 29695 名符合条件的患者。TTS 的中位数为 53.8 小时。在 51.8%的病例中，在 48 小时内进行了手术。与 2 天内手术相比，手术时间延迟超过 2 天的患者更有可能表现出 ASA 评分高于 2（58.9% vs. 41.1%，p<0.001），术后更不可能在 24 小时内实现活动（63% vs. 67.4%，p<0.001），更有可能发生压疮（10.7% vs. 6.9%，p<0.001），住院时间更长（10.7 天 vs. 6.9 天，p<0.001）。总体 30 天死亡率为 7.8%。死者的 TTS（66 小时）明显高于幸存者（56.5 小时）。手术后 2 天（7.5%）和 2 天内（5.4%）手术的患者之间在 30 天死亡率方面存在统计学上显著更高的差异。在 24 小时内手术的患者中，30 天死亡率为 5.2%，而在 120 小时以上手术的患者中，30 天死亡率为 9.2%。优势概率值为 0.44。曲线下面积达到 0.55。
TTS 与 30 天死亡率之间的关联较弱。髋关节骨折后 2 天内进行的手术与髋关节骨折后第二天的再活动明显相关，术后压疮和住院时间更短。尽管 TTS 和 30 天死亡率之间的关联较弱，但如果在 2 天内进行手术，则有一定的益处。我们的结果表明，应尽快使患者适合手术。
IV。
