Hutchison Catherine E T, Rollier Genevieve, Li Hsin-Fang, Wells Erica, Workman Kimberly L, Duwelius Paul J, Lieberman Elizabeth G
Oregon Health & Science University, Department of Orthopaedics and Rehabilitation, Portland, Oregon.
Providence St. Joseph Health, Surgery & Orthopedic Program, Portland, Oregon.
J Arthroplasty. 2025 Aug;40(8S1):S62-S67. doi: 10.1016/j.arth.2025.03.035. Epub 2025 Mar 17.
Transferring hip fracture patients may increase morbidity and cost. The purpose of this study was to examine time to surgery, outcomes, and cost in patients undergoing operative management of displaced femoral neck fractures (DFNFs), comparing those admitted through the emergency department (ED) and those transferred from outside hospitals.
A retrospective review of surgically managed DFNF patients (age ≥ 65 years) at a single institution between May 29, 2020, and December 29, 2022, was performed. Patients were categorized into two groups: "ED arrivals" and "transfers." Demographics, time from presentation to surgery, hospital length of stay, discharge disposition, 1-year readmission, reoperation, and mortality, and total cost of care were collected and compared. We identified 459 patients (ED = 422, 92.0%, Transfer = 37, 8.0%). There was no difference in age, sex, body mass index, or American Society of Anesthesiologists status.
Median time from ED to operating room was higher in the transfer group (41.6 versus 23.2 hours, P < 0.0001). Transfer and ED patients had similar length of stay (5.9 versus 6.0 days, P = 0.29) and similar rates of discharge to skilled nursing facility (66.1 versus 62.2%, P = 0.39). There was a higher rate of 1-year mortality (27.0 versus 13.5% for ED, P = 0.03) in transfer patients but no difference in 1-year readmission or reoperation. Adjusting for demographics, transfer patients had 2.6 higher odds of 1-year mortality than ED patients (odds ratio = 2.59 (1.13 to 5.94) P = 0.03). The cost of care was higher for transfer patients ($23,521 versus $13,980, P < 0.0001).
Transferring DFNF patients was associated with delayed time to surgery, increased 1-year mortality, and higher costs. Transferring patients is a logistical reality for many conditions; however, efforts should be made to provide efficient, safe, and cost-effective care.
转运髋部骨折患者可能会增加发病率和成本。本研究的目的是检查移位型股骨颈骨折（DFNF）手术治疗患者的手术时间、结局和成本，比较通过急诊科（ED）入院的患者和从外部医院转运来的患者。
对2020年5月29日至2022年12月29日期间在单一机构接受手术治疗的DFNF患者（年龄≥65岁）进行回顾性研究。患者分为两组：“急诊入院患者”和“转运患者”。收集并比较人口统计学数据、从就诊到手术的时间、住院时间、出院处置情况、1年再入院率、再次手术率和死亡率以及总护理成本。我们确定了459例患者（急诊入院 = 422例，占92.0%；转运 = 37例，占8.0%）。在年龄、性别、体重指数或美国麻醉医师协会分级方面没有差异。
转运组从急诊到手术室的中位时间更长（41.6小时对23.2小时，P < 0.0001）。转运患者和急诊入院患者的住院时间相似（5.9天对6.0天，P = 0.29），转至专业护理机构的出院率也相似（66.1%对62.2%，P = 0.39）。转运患者的1年死亡率较高（急诊入院患者为13.5%，转运患者为27.0%，P = 0.03），但1年再入院率或再次手术率没有差异。在对人口统计学因素进行调整后，转运患者1年死亡的几率比急诊入院患者高2.6倍（优势比 = 2.59（1.13至5.94），P = 0.03）。转运患者的护理成本更高（23,521美元对13,980美元，P < 0.0001）。
转运DFNF患者与手术时间延迟、1年死亡率增加和成本更高有关。对于许多情况来说，转运患者是一个后勤现实问题；然而，应努力提供高效、安全且具有成本效益的护理。
