Reduced time to surgery improves mortality and length of stay following hip fracture: results from an intervention study in a Canadian health authority
Reduced time to surgery improves mortality and length of stay following hip fracture: results from an intervention study in a Canadian health authority
复制标题
DOI：
10.1503/cjs.017714
复制
发表时间：
2015-08-01
影响因子：
2.5
通讯作者：
Oppenheimer, Luis
中科院分区：
文献类型：
--
作者：
Bohm, Eric;Loucks, Lynda;Oppenheimer, Luis
背景资料：现有文献表明延迟髋部骨折手术对死亡率的负面影响，主要是观察性研究，易于选择偏倚，可能高估延迟的负面影响。我们进行了一项干预研究，以评估旨在达到髋部骨折手术48小时基准的举措，以确定干预是否缩短了手术时间，以及手术时间的总体缩短是否改善了死亡率和住院时间。方法：我们对比了手术时间，使用Kaplan-Meier估计值和考克斯比例风险模型调整年龄，性别，结果：我们纳入了3525名50岁或以上的干预前和3007名干预后患者。在基准范围内接受手术的患者比例从66.8%增加到84.6%，中位住院时间从13.5天减少到9.7天，粗住院死亡率从9.6%减少到6.8%（所有p < 0.001）。调整后的分析显示，住院死亡率（风险比[HR] 0.68，95%置信区间[CI] 0.57-0.81）和1年死亡率（HR 0.87，95%CI 0.79-0.96）降低。独立于干预期，在48小时内进行手术证明了住院死亡的调整风险降低（HR 0.51，95%CI 0.41-0.63）和术后1年（HR 0.72，95% CI 0.64-0.80）。结论：协调一致，区域-广泛努力提高髋部骨折手术的及时性，可以成功地缩短手术时间，住院和1年时的死亡率。
Background: Existing literature demonstrating the negative impact of delayed hip fracture surgery on mortality consists largely of observational studies prone to selection bias and may overestimate the negative effects of delay. We conducted an intervention study to assess initiatives aimed at meeting a 48-hour benchmark for hip fracture surgery to determine if the intervention achieved a reduction in time to surgery, and if a general reduction in time to surgery improved mortality and length of stay.Methods: We compared time to surgery, length of stay and mortality between pre- and postintervention patients with a hip fracture using the Kaplan-Meier estimator and Cox proportional hazards model adjusting for age, sex, comorbidities, type of surgery and year.Results: We included 3525 pre- and 3007 postintervention patients aged 50 years or older. The proportion of patients receiving surgery within the benchmark increased from 66.8% to 84.6%, median length of stay decreased from 13.5 to 9.7 days, and crude in-hospital mortality decreased from 9.6% to 6.8% (all p < 0.001). Adjusted analyses revealed reduced mortality in hospital (hazard ratio [HR] 0.68, 95% confidence interval [CI] 0.57-0.81) and at 1 year (HR 0.87, 95%CI 0.79-0.96). Independent of the intervention period, having surgery within 48 hours demonstrated decreased adjusted risk of death in hospital (HR 0.51, 95%CI 0.41-0.63) and at 1 year postsurgery (HR 0.72, 95% CI 0.64-0.80).Conclusion: Coordinated, region-wide efforts to improve timeliness of hip fracture surgery can successfully reduce time to surgery and appears to reduce length of stay and adjusted mortality in hospital and at 1 year.