Ji Yunhan, Michikawa Takehiro, Zouchi Kenta, Hachiya Kurenai, Taniguchi Takumi, Sato Keigo, Ye XiaoJian, Morita Mitsuhiro, Fujita Nobuyuki
Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan.
Department of Orthopedics, Tongren Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, China.
BMC Geriatr. 2025 Jul 2;25(1):470. doi: 10.1186/s12877-025-06149-4.
Hip fractures represent a significant public health issue in an aging society. Early surgical intervention for hip fractures in older adults is associated with fewer complications and higher survival rates, and recent reimbursement incentives in Japan have aimed to encourage surgery within 48 h of injury. However, information on the determinants of delayed surgery, including reimbursement incentives, remains limited. This study aimed to investigate the number of days from admission to surgery and identify factors associated with delayed surgery using data from two acute care hospitals in Japan.
We retrospectively analyzed data from 1,209 patients aged ≥ 65 years who underwent hip fracture surgery at two hospitals in Japan between April 2021 and March 2024. Patient- and healthcare system-related factors were compared between patients who underwent surgery within 2 days of admission (E group) and those who underwent surgery at later times (L group). Poisson regression was used to identify independent factors associated with delayed surgery.
In total, 56% of patients underwent surgery within 2 days of admission. Multivariable analysis identified age ≥ 85 years (prevalence ratio [PR] = 0.81) and trochanteric fracture (PR = 0.81) as factors that reduced the prevalence of delayed surgery. Conversely, diabetes (PR = 1.18); cardiovascular disease (PR = 1.19); low serum albumin levels (PR = 2.08); admission in the pandemic period (PR = 1.26), university hospital (PR = 1.24); and admission on Thursday (PR = 1.69), Friday (PR = 2.99), or Saturday (PR = 2.60) were associated with delayed surgery. The in-hospital mortality rate was approximately 2%, with no significant difference observed between the E and L groups.
Both patient- and healthcare system–related factors were associated with delayed surgery for hip fractures in older adults. Although a reimbursement incentive has been introduced to promote early surgery, real-world challenges, including preoperative risk factors and hospital resources, continue to affect surgical timing. These findings could help inform strategies to enhance timely surgical care for older patients with hip fractures in aging societies.
在老龄化社会中，髋部骨折是一个重大的公共卫生问题。对老年人髋部骨折进行早期手术干预可减少并发症并提高生存率，日本最近的报销激励措施旨在鼓励在受伤后48小时内进行手术。然而，关于延迟手术的决定因素，包括报销激励措施的信息仍然有限。本研究旨在利用日本两家急性护理医院的数据，调查从入院到手术的天数，并确定与延迟手术相关的因素。
我们回顾性分析了2021年4月至2024年3月期间在日本两家医院接受髋部骨折手术的1209名年龄≥65岁患者的数据。比较了入院后2天内接受手术的患者（E组）和较晚接受手术的患者（L组）的患者及医疗系统相关因素。采用泊松回归分析确定与延迟手术相关的独立因素。
总体而言，56%的患者在入院后2天内接受了手术。多变量分析确定年龄≥85岁（患病率比[PR]=0.81）和转子间骨折（PR=0.81）是降低延迟手术患病率的因素。相反，糖尿病（PR=1.18）；心血管疾病（PR=1.19）；血清白蛋白水平低（PR=2.08）；大流行期间入院（PR=1.26），大学医院（PR=1.24）；以及周四（PR=1.69）、周五（PR=2.99）或周六（PR=2.60）入院与延迟手术相关。住院死亡率约为2%，E组和L组之间未观察到显著差异。
患者及医疗系统相关因素均与老年人髋部骨折延迟手术有关。尽管已引入报销激励措施以促进早期手术，但包括术前危险因素和医院资源在内的现实挑战继续影响手术时机。这些发现有助于为老龄化社会中提高老年髋部骨折患者及时手术治疗的策略提供信息。
