Zuckerman J D, Skovron M L, Koval K J, Aharonoff G, Frankel V H
Geriatric Hip Fracture Research Group, Hospital for Joint Diseases, New York, NY 10003, USA.
J Bone Joint Surg Am. 1995 Oct;77(10):1551-6. doi: 10.2106/00004623-199510000-00010.
We prospectively studied 367 patients who had a fracture of the hip, to determine the effect of an operative delay on postoperative complications and on the one-year mortality rate. All of the patients were at least sixty-five years old, cognitively intact, living at home, and able to walk before the fracture. An operative delay was defined as an interval of three calendar days or more between the time of admission to the hospital and the operation. The operation was performed within two calendar days after admission in 267 (73 per cent) of the patients. When the factors of the patient's age and sex and the number of pre-existing medical conditions were controlled, it was found that an operative delay beyond this period approximately doubled the risk of the patient dying before the end of the first postoperative year. When the patient's age and sex and the severity of pre-existing medical conditions were controlled, there was also an increase in mortality associated with an operative delay, although this was not significant. With the numbers studied, an operative delay beyond two calendar days did not have a significant effect on the prevalence of complications during hospitalization. We concluded that an operative delay of more than two calendar days after admission is an important predictor of mortality within one year for elderly patients who have a fracture of the hip and who are cognitively intact, able to walk, and living at home before the fracture. Optimally, such patients should have the operation within two calendar days after admission to the hospital.
我们前瞻性地研究了367例髋部骨折患者，以确定手术延迟对术后并发症及一年死亡率的影响。所有患者年龄均在65岁及以上，认知功能正常，骨折前居家生活且能够行走。手术延迟定义为入院时间与手术时间间隔3个日历日或更长时间。267例（73%）患者在入院后2个日历日内接受了手术。在对患者年龄、性别及并存疾病数量等因素进行控制后发现，超过这一时间段的手术延迟使患者在术后第一年内死亡风险增加了约一倍。在对患者年龄、性别及并存疾病严重程度进行控制后，手术延迟也与死亡率增加相关，尽管并不显著。就所研究的病例数量而言，超过2个日历日的手术延迟对住院期间并发症发生率并无显著影响。我们得出结论，对于髋部骨折、认知功能正常、骨折前能够行走且居家生活的老年患者，入院后手术延迟超过2个日历日是一年内死亡的重要预测因素。理想情况下，此类患者应在入院后2个日历日内接受手术。
