The treatment of hip fractures - Variations in care
The treatment of hip fractures - Variations in care
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DOI：
10.1097/01.blo.0000188558.67172.4e
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发表时间：
2006-01-01
影响因子：
4.2
通讯作者：
Chilcott, Marisha
中科院分区：
文献类型：
--
作者：
Lieberman, Jay R.;Romano, Patrick S.;Chilcott, Marisha
本描述性研究的目的是确定老年髋部骨折患者的手术治疗范围、围手术期处理和死亡率。我们回顾性地确定了1001例老年患者，他们在加州的49家中、高容量医院接受了髋关节骨折的手术治疗，采用了髋关节骨折住院的两阶段分层整群抽样。这种抽样方法允许产生加权估计，描述了1995年至1996年加州所有髋部骨折患者的整体护理。住院、30天和6个月的死亡率分别为1.7%、5%和12%。双极半关节置换术的使用率高于单极植入物（73% vs 26%）。对于髋关节骨折患者的护理，存在一些偏离，特别是与抗生素给药和深静脉血栓预防相关的偏离。14%的患者在手术前和手术期间没有接受任何抗生素预防，24%的患者在手术开始后4小时内没有接受预防。24%的患者未接受深静脉血栓预防，81%的患者出院后未接受预防。外科医生需要不断评估髋部骨折患者的治疗方案，以优化护理。
The purpose of this descriptive study was to identify the ranges of operative treatment, perioperative management, and mortality rate of elderly patients with hip fractures. We retrospectively identified 1001 elderly patients who had operative treatment for a fractured hip in 49 medium- and high-volume California hospitals using a two-stage stratified cluster sample of hospitalizations for hip fractures. This sampling method allowed for generation of weighted estimates that described the overall care of all patients with hip fractures in California from 1995 to 1996. The in-hospital, 30-day, and 6-month mortality rates were 1.7%, 5%, and 12% respectively. Bipolar hemiarthroplasties were used more often than unipolar implants (73% versus 26%). There were some deviations from generally accepted guidelines for care of patients with hip fractures particularly related to administration of antibiotic and deep vein thrombosis prophylaxis. Fourteen percent of patients did not receive any antibiotic prophylaxis before and during surgery, and 24% did not receive prophylaxis within 4 hours of the beginning of the surgical procedure. Twenty-four percent of patients received no prophylaxis for deep vein thrombosis, and 81% of patients did not receive prophylaxis after hospital discharge. Surgeons need to continually evaluate the treatment regimens for patients with hip fractures to optimize care.