The effect of hospital type and surgical delay on mortality after surgery for hip fracture
The effect of hospital type and surgical delay on mortality after surgery for hip fracture
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DOI：
10.1302/0301-620x.87b3.15300
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发表时间：
2005-03-01
影响因子：
--
通讯作者：
Kreder, HJ
中科院分区：
文献类型：
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作者：
Weller, I;Wai, EK;Kreder, HJ
髋部骨折后第一年内的死亡可能受到患者接受治疗的医院类型以及等待手术的时间的影响。我们研究了加拿大安大略的57315例髋部骨折患者。与在城市社区机构治疗的患者相比，在教学医院治疗的患者院内死亡风险降低（比值比（OR）0.89; 95%置信区间（CI）0.83至0.97）。农村社区医院的死亡率比城市社区医院有上升的趋势。住院死亡率随手术延迟增加而增加（OR 1.13; 95% CI 1.10至1.16），延迟1天，延迟2天以上更高（OR 1.60; 95% CI 1.42至1.80）。这种关系在年龄小于70岁且无合并症的患者中最强，但与医院状况无关。在手术后三个月和一年观察到类似的关系。这表明，任何非医疗原因的手术延迟都对患者的结果不利。
Death during the first year after hip fracture may be influenced by the type of hospital in which patients are treated as well as the time spent awaiting surgery. We studied 57 315 hip fracture patients who were admitted to hospital in Ontario, Canada. Patients treated in teaching hospitals had a decreased risk of in-hospital mortality (odds ratio (OR) 0.89; 95% confidence interval (CI) 0.83 to 0.97) compared with those treated in urban community institutions. There was a trend toward increased mortality in rural rather than urban community hospitals. In-hospital mortality increased as the surgical delay increased (OR 1.13; 95% Cl 1.10 to 1.16) for a one-day delay and higher (OR 1.60; 95% Cl 1.42 to 1.80) for delays of more than two days. This relationship was strongest for patients younger than 70 years of age and with no comorbidities but was independent of hospital status. Similar relationships were seen at three months and one year after surgery. This suggests that any delay to surgery for non-medical reasons is detrimental to a patient's outcome.