The 30-day survival and recovery after hip fracture by timing of mobilization and dementia : a UK database study.
The 30-day survival and recovery after hip fracture by timing of mobilization and dementia : a UK database study.
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DOI：
10.1302/0301-620x.103b7.bjj-2020-2349.r1
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发表时间：
2021-07
期刊：
影响因子：
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通讯作者：
Sheehan KJ
中科院分区：
文献类型：
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作者：
Goubar A;Martin FC;Potter C;Jones GD;Sackley C;Ayis S;Sheehan KJ
在英格兰和威尔士，比较早期活动（手术当天或术后第二天）和晚期活动（术后2天或更长时间）患者的30天生存率和骨折前骨关节恢复情况。确定痴呆的存在是否影响动员时间与30天生存和恢复之间的关联。国家髋部骨折数据库的分析与2014年至2016年期间英格兰/威尔士126，897例≥60岁髋部骨折手术治疗患者的住院记录相关。使用逻辑回归，我们调整了协变量与倾向评分，以估计动员时间和生存率和Ambassador恢复之间的关联。99，667例（79%）患者早期活动。早期动员与晚期动员相比，30天时生存的加权比值比为1.92（95%CI 1.80 - 2.05），恢复室外活动的加权比值比为1.25（95%CI 1.03 - 1.51），恢复室内活动的加权比值比为1.53（95%CI 1.32 - 1.78）。早期动员和晚期动员患者入院后30天的加权生存概率（%）分别为95.9（95% CI 95.7 - 96.0）和92.4（95% CI 92.0 - 92.8）。在室外和室内骨折前骨折的情况下，早期活动的患者骨折恢复的加权概率分别为9.7（95%CI 9.2-10.2）和81.2（95%CI 80.0-82.4），晚期活动的患者骨折恢复的加权概率分别为7.9（95%CI 6.6 - 9.2）和73.8（95%CI 71.3 - 76.2）。尽管观察到痴呆患者和非痴呆患者的生存率和运动恢复相关，但痴呆患者不太可能早期活动。早期活动与髋部骨折后患者（伴或不伴痴呆）的生存和恢复相关。早期动员应作为衡量质量的指标。未能及早动员的原因也应该被捕获，以告知质量改进计划。
To compare 30-day survival and recovery of prefracture ambulation between patients mobilised early (on the day of or day after surgery) and patients mobilised late (2 days of more after surgery) in England and Wales. To determine whether the presence of dementia influences the association between mobilisation timing and 30-day survival and recovery. Analysis of the National Hip Fracture Database linked to hospitalisation records for 126,897 patients ≥60 years surgically treated for hip fracture in England/Wales between 2014 and 2016. Using logistic regression, we adjusted for covariates with a propensity score to estimate the association between mobilisation timing and survival and ambulation recovery. 99,667 (79%) patients mobilised early. Among those mobilised early compared to those mobilised late, the weighted odds ratio of survival was 1.92 (95% CI 1.80 – 2.05), of recovering outdoor ambulation was 1.25 (95% CI 1.03 – 1.51), and of recovering indoor ambulation was 1.53 (95% CI 1.32 – 1.78) by 30 days. The weighted probability (%) of survival at 30-days post-admission were 95.9 (95% CI 95.7 – 96.0) and 92.4 (95% CI 92.0 – 92.8) respectively among those mobilised early and those mobilised late. The weighted probability of ambulation recovery given outdoor and indoor ambulation prefracture were 9.7 (95% CI 9.2-10.2) and 81.2 (95% CI 80.0-82.4) respectively among those mobilised early, and were 7.9 (95% CI 6.6 – 9.2) and 73.8 (95% CI 71.3 – 76.2) respectively among those mobilised late. Patients with dementia were less likely to mobilise early despite observed associations with survival and ambulation recovery for those with and without dementia. Early mobilisation was associated with survival and recovery for patients (with and without dementia) after hip fracture. Early mobilisation should be incorporated as a measured indicator of quality. Reasons for failure to mobilise early should also be captured to inform quality improvement initiatives.