Hartmann Yasmin, Rascher Katherine, Pishnamaz Miguel, Migliorini Filippo, Horst Klemens, Knobe Matthias, Hildebrand Frank, Weber Christian David
München Klinik gGmbH, München, Deutschland.
AUC-Academy for Trauma Surgery (AUC), München, Deutschland.
Unfallchirurgie (Heidelb). 2025 Aug 25. doi: 10.1007/s00113-025-01619-1.
There is an almost unique certification structure in Germany in which clinics can be certified either as trauma center DGU® (TraumaZentrum DGU®), geriatric trauma center DGU® (AltrsTraumaZentrum DGU®) or arthroplasty center (endoCert), among others. Geriatric patients with displaced femoral neck fractures represent a highly relevant entity. The structural and process quality are validated within the framework of certification as both an AltersTraumaZentrum DGU® (ATZ) and arthroplasty center (EPZ), which represents a methodologically challenging approach to the analysis of treatment reality.
Is there a treatment variation between certified geriatric trauma centers (ATZ) and dual certified geriatric and arthroplasty centers (ATZ+EPZ) with respect to joint-preserving or joint replacement surgical procedures for geriatric displaced femoral neck fractures and short-term complications?
Data from the Registry for Geriatric Trauma of the German Trauma Society (ATR-DGU) from 46 clinics with ATZ and 52 clinics with ATZ + EPZ were analyzed. The follow-up period included both the in-hospital stay and a 120-day follow-up interval. The primary outcome was mortality, secondary endpoints included mobility, reoperations and health status. Univariate and multivariate analyses were performed to calculate odds ratios (OR) after adjustment for age, gender, ASA score and concomitant injuries.
The median age of the collective (n = 7389) was 84 years, 29.6% and 29.8% respectively were male, the median time until surgery was 20.9 h (ATZ) vs. 20.5 h (ATZ + EPZ) and the median length of stay was 15.1 days for both types of center. The number of joint-preserving interventions was significantly increased in ATZ compared to clinics with dual certification (ATZ: 8.6% vs. ATZ + EPZ: 2.6%; OR = 3.63). The reoperation rate was comparable in the primary stay (3.7% vs. 3.9%) but was significantly increased over the 120-day course in clinics with dual certification (4.1% vs. 6.0%; p = 0.022). Revisions due to periprosthetic fractures occurred more frequently in ATZ without EPZ (8.2% vs. 3.5%). The multivariate analysis showed an increased mortality in the acute phase (OR 1.26; 1.02-1.56; p = 0.031), an increased rate of reoperations in the 120-day course (OR 1.45; 1.06-2.02; p = 0.024) and inpatient readmissions (OR 1.42, 1.02-2.00; p = 0.043) for centers with dual certification.
In Germany an institutional treatment variation for geriatric displaced femoral neck fractures exists. In certified geriatric trauma centers without certified arthroplasty center there is a significantly increased rate of joint-preserving treatment with differences in terms of morbidity and mortality in the acute phase.
德国有一种几乎独一无二的认证结构，诊所可以被认证为创伤中心DGU®（创伤中心DGU®）、老年创伤中心DGU®（老年创伤中心DGU®）或关节置换中心（endoCert）等。老年股骨颈移位骨折患者是一个高度相关的群体。在作为老年创伤中心DGU®（ATZ）和关节置换中心（EPZ）的认证框架内，结构和流程质量得到了验证，这代表了一种对治疗实际情况进行分析的具有方法学挑战性的方法。
在老年股骨颈移位骨折的保关节或关节置换手术及短期并发症方面，经认证的老年创伤中心（ATZ）与同时获得老年创伤和关节置换双重认证的中心（ATZ+EPZ）之间是否存在治疗差异？
分析了来自德国创伤协会老年创伤登记处（ATR-DGU）的数据，其中包括46家ATZ诊所和52家ATZ+EPZ诊所的数据。随访期包括住院时间和120天的随访间隔。主要结局是死亡率，次要终点包括活动能力、再次手术和健康状况。在对年龄、性别、ASA评分和伴随损伤进行调整后，进行单因素和多因素分析以计算优势比（OR）。
总体人群（n=7389）的中位年龄为84岁，男性分别占29.6%和29.8%，ATZ组手术前的中位时间为20.9小时，ATZ+EPZ组为20.5小时，两种类型中心的中位住院时间均为15.1天。与双重认证的诊所相比，ATZ中保关节干预的数量显著增加（ATZ：8.6% 对ATZ+EPZ：2.6%；OR=3.63）。初次住院期间的再次手术率相当（3.7%对3.9%），但在双重认证的诊所中，120天期间的再次手术率显著增加（4.1%对6.0%；p=0.022）。无EPZ的ATZ中因假体周围骨折进行的翻修手术更为频繁（8.2%对3.5%）。多因素分析显示，双重认证中心在急性期死亡率增加（OR 1.26；1.02-1.56；p=0.031），120天期间再次手术率增加（OR 1.45；1.06-2.02；p=0.024）以及住院再入院率增加（OR 1.42，1.02-2.00；p=0.043）。
在德国，老年股骨颈移位骨折存在机构间治疗差异。在没有认证关节置换中心的经认证老年创伤中心，保关节治疗率显著增加，且在急性期的发病率和死亡率方面存在差异。
