周末入院对髋部骨折死亡率的影响。
Effect of Weekend Admission on Hip Fracture Mortality.
作者信息
Newcomb Nicholas L, Urvater Marlena, Doig Ian E, Mullen Michael, Cooke Cameron M
机构信息
Department of Orthopaedics, University of New Mexico, Albuquerque, NM.
The University of Queensland Medical School, Ochsner Clinical School, New Orleans, LA.
出版信息
Ochsner J. 2025 Spring;25(1):2-10. doi: 10.31486/toj.24.0017.
BACKGROUND
Weekend vs weekday hospital admission has been associated with poorer mortality rates for many conditions. Studies evaluating weekend admission for hip fractures have resulted in contradictory conclusions regarding outcomes.
METHODS
We conducted a retrospective analysis of all patients who underwent surgery for a fragility hip fracture at a quaternary level teaching hospital during a 6-year period. A total of 1,164 patients were included: 796 weekday admissions (Monday through Friday) vs 368 weekend admissions (Saturday and Sunday). Patients were subdivided based on surgeon experience level (473 consultants vs 690 nonconsultants). Statistical tests included chi-square tests and logistic regression. Demographic data included age, sex, prior hip fracture, fracture type, operation, and American Society of Anesthesiologists grade. The primary outcome was 1-year mortality. Secondary outcomes were acute mortality (<24 hours), subacute mortality (1 to 30 days), change in mobility from baseline at 1 year, preoperative delay (>48 hours), and surgical duration.
RESULTS
The weekend admission cohort had a higher 1-year mortality rate than the weekday admission cohort (30.4% vs 23.2%; =0.029), while subacute mortality trended toward significance (=0.083). No significant difference was seen in acute mortality (=0.5). Hemiarthroplasty was associated with increased mortality at 12 months (=0.012) compared to the other operative interventions. The median duration of surgery was lower in the weekend cohort vs the weekday cohort (1.15 hours [69 minutes] vs 1.23 hours [73.8 minutes]; <0.001). Consultants performed surgeries 16.2 minutes faster than nonconsultants (<0.001) and trended toward a lower 1-year mortality rate (22.1% vs 27.9%; =0.058). No significant difference was seen in mobility change at 1 year in both the consultant vs nonconsultant analysis (>0.9) and in the weekday vs weekend analysis (>0.12).
CONCLUSION
A significantly increased 1-year mortality rate and a shorter surgical duration were observed among patients admitted on the weekends.
背景
对于多种病症，周末住院与更高的死亡率相关。评估髋部骨折周末住院情况的研究在结局方面得出了相互矛盾的结论。
方法
我们对一家四级教学医院6年间因脆性髋部骨折接受手术的所有患者进行了回顾性分析。共纳入1164例患者：796例工作日入院患者（周一至周五）和368例周末入院患者（周六和周日）。患者根据外科医生经验水平进行细分（473名顾问医生与690名非顾问医生）。统计检验包括卡方检验和逻辑回归。人口统计学数据包括年龄、性别、既往髋部骨折、骨折类型、手术、美国麻醉医师协会分级。主要结局为1年死亡率。次要结局为急性死亡率（<24小时）、亚急性死亡率（1至30天）、1年时与基线相比的活动能力变化、术前延迟（>48小时）和手术时长。
结果
周末入院队列的1年死亡率高于工作日入院队列（30.4%对23.2%；P=0.029），而亚急性死亡率有显著差异趋势（P=0.083）。急性死亡率无显著差异（P=0.5）。与其他手术干预相比，半髋关节置换术在12个月时与死亡率增加相关（P=0.012）。周末队列的手术中位时长低于工作日队列（1.15小时[69分钟]对1.23小时[73.8分钟]；P<0.001）。顾问医生的手术速度比非顾问医生快16.2分钟（P<0.001），且1年死亡率有降低趋势（22.1%对27.9%；P=0.0五四）。在顾问医生与非顾问医生分析（P>0.9）以及工作日与周末分析（P>0.12）中，1年时的活动能力变化均无显著差异。
结论
观察到周末入院患者的1年死亡率显著增加且手术时长较短。
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