Early Morbidity but Not Mortality Increases With Surgery Delayed Greater Than 24 Hours in Patients With a Periprosthetic Fracture of the Hip
Early Morbidity but Not Mortality Increases With Surgery Delayed Greater Than 24 Hours in Patients With a Periprosthetic Fracture of the Hip
复制标题
DOI：
10.1016/j.arth.2019.06.027
复制
发表时间：
2019-11-01
影响因子：
3.5
通讯作者：
Shah, Roshan P.
中科院分区：
文献类型：
--
作者：
Boddapati, Venkat;Grosso, Matthew J.;Shah, Roshan P.
背景：研究表明，自体髋关节骨折后，加快手术时间可能会降低发病率和死亡率。髋关节假体周围骨折（PPF）后的这种相关性尚不清楚。本研究的目的是评估手术时间对30天并发症发生率的影响。方法：使用国家手术质量改进计划注册表来识别2005年至2016年期间接受髋关节PPF手术干预的所有患者。根据从入院到手术的时间，将患者分为2个队列，24小时（非加速）。30天的结果变量进行了评估，使用双变量和多变量analysis.Results：我们确定了857例接受手术干预髋关节PPF，其中402（46.9%）进行了加急手术和455（53.1%）进行非加急手术。非加速手术患者的平均手术时间为2.4天（范围：1-14天）。校正基线患者特征差异的多变量分析显示，非加速手术患者的总体并发症发生率较高（比值比[OR] = 1.72; P = .014），呼吸系统并发症（OR = 4.15; P = 0.0029）、尿路感染（OR = 2.77; P = 0.020）、离家出走（OR = 2.22; P <0.001）和输血（OR = 1.86; P <0.001）。死亡率无统计学差异（P = 0.093）。非加速手术的患者的总住院时间和术后住院时间也更长（+2.7天; P < .001）。结论：本研究并未发现死亡率有任何统计学差异，但发现与术后并发症增加和非加速手术有关PPF。可能需要进一步的前瞻性研究来确定这种关联背后的致病因素。(C)2019由Elsevier Inc.出版
Background: Studies have identified a possible morbidity and mortality benefit with expedited time to surgery after a native hip fracture. This association after hip periprosthetic fractures (PPF) has been less clearly delineated. The purpose of this study is to assess the effect of time to surgery on rates of 30-day complications.Methods: The National Surgical Quality Improvement Program registry was used to identify all patients who underwent surgical intervention for hip PPF between 2005 and 2016. Patients were stratified into 2 cohorts based on time from hospital admission to surgery, either 24 hours (non-expedited). Thirty-day outcome variables were assessed using bivariate and multivariate analyses.Results: We identified 857 patients undergoing surgical intervention for hip PPF, of whom 402 (46.9%) underwent expedited surgery and 455 (53.1%) underwent non-expedited surgery. Patients with non-expedited surgery had an average time to surgery of 2.4 days (range, 1-14 days). Multivariate analysis adjusting for differences in baseline patient characteristics revealed that patients with a non-expedited procedure had higher rates of overall complications (odds ratio [OR] = 1.72; P = .014), respiratory complications (OR = 4.15; P = .0029), urinary tract infections (OR = 2.77; P = .020), nonhome discharge (OR = 2.22; P < .001), and blood transfusions (OR = 1.86; P < .001). There was no statistical difference in mortality (P = .093). Patients with non-expedited surgery also had longer total and postoperative (+2.7 days; P < .001) length of stay.Conclusion: This study did not identify any statistical difference in mortality but found an association with increased postoperative complications and non-expedited surgery for PPF. Additional prospective studies may be warranted to identify the causative factors behind this association. (C) 2019 Published by Elsevier Inc.