Boukebous Baptiste, Gao Fei, Biau David
AP-HP - Orthopédie et Traumatologie, Hôpital Beaujon 100 Bd du Général Leclerc, Clichy 92110, France.
Université Paris Cité, Paris, France.
Age Ageing. 2025 May 3;54(5). doi: 10.1093/ageing/afaf116.
Time to surgery (TTS) increases mortality risk in old patients with proximal femur fractures (PFFs). Orthogeriatric care pathways reduce mortality and length of stay, but the interaction between TTS and geriatric intervention remains unclear.
To identify organisational variables-including geriatric intervention-that are predictive of 90-day mortality and explore their interactions with TTS.
This retrospective study included 7756 PFFs aged over 60 who underwent surgery between 2005 and 2017. Organisational factors influencing 90-day mortality (main outcome) were identified in an administrative database using log-rank tests. Variables such as a mobile geriatric team (MGT) intervening in the emergency department were screened. Selected variables were included in a Cox model alongside TTS and the AtoG score, a validated multidimensional prognostic tool (from 0 no comorbidity to ≥5). Statistical interactions between TTS and organisational variables were calculated.
MGT was one of the rare organisational variables with a protective effect: hazard ratio (HR) = 0.81, CI 95% [0.68-0.98], P = 0.03. MGT's strongest effect was for TTS up to 1 day (HR = 0.70, CI95% [0.53-0.92], P = 0.01) and then decreased beyond 2 days (HR = 0.97, CI95% [0.73-1.3], P = 0.08). In patients with an AtoG score ≤ 2, MGT was the strongest parameter: HR = 0.76, CI95% [0.60-0.93], P = 0.03, while the HR for TTS was 1.01 CI 95% [0.99; 1.02], P = 0.15. In patients with an AtoG>2, there was a synergic interaction between MGT and reduced TTS (P = 0.05).
Geriatric intervention modulated the effect of TTS on 90-day mortality up to a TTS of 2 days. MGT had a positive impact on both vulnerable and earthier patients.
手术时间（TTS）会增加老年股骨近端骨折（PFF）患者的死亡风险。骨科老年护理路径可降低死亡率和住院时间，但TTS与老年干预之间的相互作用仍不明确。
确定包括老年干预在内的组织变量，这些变量可预测90天死亡率，并探讨它们与TTS的相互作用。
这项回顾性研究纳入了2005年至2017年间接受手术的7756例60岁以上的PFF患者。使用对数秩检验在行政数据库中确定影响90天死亡率（主要结局）的组织因素。筛选了诸如在急诊科进行干预的流动老年团队（MGT）等变量。将选定变量与TTS和AtoG评分（一种经过验证的多维预后工具，从0无合并症到≥5）一起纳入Cox模型。计算TTS与组织变量之间的统计相互作用。
MGT是具有保护作用的少数组织变量之一：风险比（HR）=0.81，95%置信区间[0.68-0.98]，P=0.03。MGT对TTS长达1天的影响最强（HR=0.70，95%置信区间[0.53-0.92]，P=0.01），然后在超过2天后下降（HR=0.97，95%置信区间[0.73-1.3]，P=0.08）。在AtoG评分≤2的患者中，MGT是最强参数：HR=0.76，95%置信区间[0.60-0.93]，P=0.03，而TTS的HR为1.01，95%置信区间[0.99；1.02]，P=0.15。在AtoG>2的患者中，MGT与缩短的TTS之间存在协同相互作用（P=0.05）。
老年干预在TTS长达两天的时间内调节了TTS对90天死亡率的影响。MGT对脆弱患者和病情较轻患者均有积极影响。
