Onizuka Naoko, Alain Gabriel, Farmer Samuel, Quatman-Yates Catherine C, Quatman Carmen E
Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA.
Orthopedic Surgery, Park Nicollet Methodist Hospital, Saint Louis Park, MN, USA.
Geriatr Orthop Surg Rehabil. 2025 Jun 16;16:21514593251350516. doi: 10.1177/21514593251350516. eCollection 2025.
Distal femur fractures are the second most common femoral fragility fractures in older adults, with postoperative mortality rates similar to or exceeding those of hip fractures. While early surgery has been shown to improve outcomes in hip fracture patients, its impact on distal femur fractures remains unclear. This study examines the relationship between surgical timing and postoperative outcomes in distal femur fracture patients.
This retrospective cohort study utilized the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database to identify patients aged 65 and older who underwent surgery for distal femur fractures between 2015 and 2022. Patients were categorized into early (within 1 day), intermediate (between 1-2 days), and delayed (>2 days) surgery groups. The primary outcome was 30-day mortality. Secondary outcomes included postoperative complications, length of hospital stay (LOS), and hospital readmission rates. Multivariate logistic regression was performed to adjust for potential confounders.
A total of 4500 cases met the inclusion criteria, with 67% undergoing surgery within one day, 20% within 1-2 days, and 13% after more than two days. After adjustment for baseline characteristics, early surgery was not associated with a significant reduction in 30-day mortality (OR: 1.00, 95% CI: 0.57-1.83, = 0.99). However, the risk of urinary tract infections (UTIs) was significantly lower in the early surgery group (adjusted OR: 0.61, 95% CI: 0.43-0.88, = 0.01). No significant differences were observed for other major complications.
Unlike in hip fractures, early surgery did not significantly impact mortality or most postoperative complications in distal femur fracture patients. However, it was associated with a reduced risk of UTIs. These findings suggest that surgical timing may be less critical than preoperative optimization and comprehensive perioperative care in improving outcomes for this population.
股骨远端骨折是老年人中第二常见的股骨脆性骨折，其术后死亡率与髋部骨折相似或超过髋部骨折。虽然早期手术已被证明可改善髋部骨折患者的预后，但其对股骨远端骨折的影响仍不明确。本研究探讨了股骨远端骨折患者手术时机与术后预后之间的关系。
这项回顾性队列研究利用美国外科医师学会国家外科质量改进计划（ACS NSQIP）数据库，识别2015年至2022年间接受股骨远端骨折手术的65岁及以上患者。患者被分为早期（1天内）、中期（1 - 2天之间）和延迟（>2天）手术组。主要结局是30天死亡率。次要结局包括术后并发症、住院时间（LOS）和医院再入院率。进行多因素逻辑回归以调整潜在混杂因素。
共有4500例病例符合纳入标准，其中67%在1天内接受手术，20%在1 - 2天内接受手术，13%在两天以上接受手术。在调整基线特征后，早期手术与30天死亡率的显著降低无关（比值比：1.00，95%置信区间：0.57 - 1.83，P = 0.99）。然而，早期手术组尿路感染（UTIs）的风险显著较低（调整后比值比：0.61，95%置信区间：0.43 - 0.88，P = 0.01）。其他主要并发症未观察到显著差异。
与髋部骨折不同，早期手术对股骨远端骨折患者的死亡率或大多数术后并发症没有显著影响。然而，它与尿路感染风险降低有关。这些发现表明，在改善该人群的预后方面，手术时机可能不如术前优化和全面的围手术期护理关键。
