Chiasson P M, Roy P D, Mitchell M J, Chiasson A M, Alexander D I
Department of Surgery, Dalhousie University, Halifax, NS.
Can J Surg. 1997 Oct;40(5):383-9.
To determine quality of hip fracture services provided by "generalist" general surgeons (generalists) in Nova Scotia.
Chart review and postoperative, blinded, random-ordered radiologic analysis.
Three community hospitals and 1 tertiary care hospital in Nova Scotia.
Seven generalists who performed 120 hip fracture repairs and 7 orthopedic surgeons (specialists) who performed 135 hip fracture repairs.
Patient demographics, preoperative, perioperative, postoperative and discharge information, technical quality of reduction as determined through postoperative radiologic assessment.
There were no differences between patients treated by generalists and those treated by specialists with respect to age, sex, American Society of Anesthesiologists' class, level of function and fracture type. Intraoperatively, the patient groups were similar with respect to type of anesthesia, use of antibiotics, number of transfusions and surgical complications. Significant differences were noted in length of operation (54.4 v. 41.1 minutes), use of C-arm imaging (6.7% v. 85.9%) and management of Garden classes 1 and 2 subcapital fractures. Postoperatively, the 2 groups had similar numbers of medical complications, wound complications, reoperations, readmissions and deaths, and a similar level of function on discharge. Significant differences included the number of intensive care unit admissions (5.8% v. 15.6%) and length of stay there (5.7 v. 2.8 days) and of postoperative stay (14.5 v. 10.7 days). The assessment of radiographs did not demonstrate any significant difference in the quality of reduction.
In Nova Scotia the outcomes of hip fracture surgery performed by generalists are comparable to those performed by specialists.
确定新斯科舍省“普通”普通外科医生（全科医生）提供的髋部骨折治疗服务质量。
病历审查以及术后盲法随机排序的放射学分析。
新斯科舍省的三家社区医院和一家三级护理医院。
实施120例髋部骨折修复手术的7名全科医生以及实施135例髋部骨折修复手术的7名骨科医生（专科医生）。
患者人口统计学资料、术前、围手术期、术后及出院信息，通过术后放射学评估确定的复位技术质量。
在年龄、性别、美国麻醉医师协会分级、功能水平和骨折类型方面，全科医生治疗的患者与专科医生治疗的患者之间没有差异。术中，两组患者在麻醉类型、抗生素使用、输血次数和手术并发症方面相似。在手术时长（54.4对41.1分钟）、C型臂成像的使用（6.7%对85.9%）以及Garden 1级和2级股骨头下骨折的处理方面存在显著差异。术后，两组的医疗并发症、伤口并发症、再次手术、再次入院和死亡人数相似，出院时功能水平也相似。显著差异包括重症监护病房入住人数（5.8%对15.6%）、在重症监护病房的住院时长（5.7对2.8天）以及术后住院时长（14.5对10.7天）。X线片评估未显示复位质量有任何显著差异。
在新斯科舍省，全科医生实施的髋部骨折手术结果与专科医生相当。
