Beringer T R, Crawford V L, Brown J G
Department of Health Care for the Elderly, Royal Victoria Hospital, Belfast.
Ulster Med J. 1996 May;65(1):32-8.
To ascertain the influence of surgical delay on outcome after proximal femoral fracture in elderly females, a cohort study of patients presenting in 1987 was compared to 1989/90. Organisational changes in the intervening period were introduced to reduce delay to surgical intervention. Two hundred and eighty females aged 65 years and over presenting from the local catchment area of an acute inner-city teaching hospital were enrolled in the study. Seventy-nine patients received surgery in 1987 and 186 in 1989/90. The one year mortality was 34% and 26% respectively. The proportion receiving surgery within 24 hours rose from 34% in 1987 to 57% in 1989/90. The relative hazard of the group receiving surgery on day 2 in comparison to day 1 was 1.7 (95% CI 1.0 to 2.9) when adjusted for co-variance of age and mental score. Medically fit elderly patients presenting with proximal femoral fracture have improved survival with early surgery within 24 hours of admission. Improvements in the organisation of hospital care will result in important benefits for the increasing number of elderly females presenting with proximal femoral fracture.
为确定手术延迟对老年女性股骨近端骨折预后的影响，对1987年与1989/1990年就诊的患者进行了一项队列研究。在此期间引入了组织变革以减少手术干预的延迟。来自一家市中心急性教学医院当地服务区域的280名65岁及以上的女性被纳入研究。1987年有79名患者接受了手术，1989/1990年有186名。一年死亡率分别为34%和26%。在24小时内接受手术的比例从1987年的34%升至1989/1990年的57%。在对年龄和精神评分的协变量进行调整后，第2天接受手术的组与第1天相比的相对风险为1.7（95%可信区间1.0至2.9）。因股骨近端骨折就诊的身体状况良好的老年患者在入院24小时内尽早手术可提高生存率。医院护理组织的改善将为越来越多因股骨近端骨折就诊的老年女性带来重要益处。
