Early surgery for patients with a fracture of the hip decreases 30-day mortality
Early surgery for patients with a fracture of the hip decreases 30-day mortality
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DOI：
10.1302/0301-620x.97b1.35041
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发表时间：
2015-01-01
影响因子：
4.6
通讯作者：
Parker, M. J.
中科院分区：
文献类型：
--
作者：
Bretherton, C. P.;Parker, M. J.
关于手术延迟对髋关节骨折患者死亡率的影响，已经进行了广泛的讨论。尽管许多研究提供的证据水平较低，但已达成共识，即延迟> 48小时对生存不利。这项前瞻性观察性研究的目的是确定早期手术是否能提高30天的生存率。在1989年至2013年期间，前瞻性收集了彼得伯勒市医院髋关节骨折患者的数据。根据入院和手术之间的时间间隔将他们分组。这些阈值范围从< 6小时到49至72小时。评估的结局为30天死亡率。使用多变量二元逻辑回归分析对混杂因素进行调整。共有6638名年龄> 60岁的患者入选。（p < 0.001），年龄增加（p < 0.001）和囊外骨折（p < 0.019）增加了30天死亡率的风险。（p = 0.014）、简易心理测试评分（p < 0.001）和女性性别（p = 0.014）改善了生存率。在调整这些混杂因素后，与12小时后手术相比，12小时前手术改善了生存率（p = 0.013）。除此之外，手术延迟的增加对30天死亡率没有显著影响。
There has been extensive discussion about the effect of delay to surgery on mortality in patients sustaining a fracture of the hip. Despite the low level of evidence provided by many studies, a consensus has been accepted that delay of > 48 hours is detrimental to survival. The aim of this prospective observational study was to determine if early surgery confers a survival benefit at 30 days.Between 1989 and 2013, data were prospectively collected on patients sustaining a fracture of the hip at Peterborough City Hospital. They were divided into groups according to the time interval between admission and surgery. These thresholds ranged from < 6 hours to between 49 and 72 hours. The outcome which was assessed was the 30-day mortality. Adjustment for confounders was performed using multivariate binary logistic regression analysis. In all, 6638 patients aged > 60 years were included.Worsening American Society of Anaesthesiologists grade (p < 0.001), increased age (p < 0.001) and extracapsular fracture (p < 0.019) increased the risk of 30-day mortality.Increasing mobility score (p = 0.014), mini mental test score (p < 0.001) and female gender (p = 0.014) improved survival. After adjusting for these confounders, surgery before 12 hours improved survival compared with surgery after 12 hours (p = 0.013). Beyond this the increasing delay to surgery did not significantly affect the 30-day mortality.