Timing matters in hip fracture surgery: patients operated within 48 hours have better outcomes. A meta-analysis and meta-regression of over 190,000 patients.
Timing matters in hip fracture surgery: patients operated within 48 hours have better outcomes. A meta-analysis and meta-regression of over 190,000 patients.
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DOI：
10.1371/journal.pone.0046175
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发表时间：
2012
期刊：
影响因子：
3.7
通讯作者：
Banfi G
中科院分区：
文献类型：
--
作者：
Moja L;Piatti A;Pecoraro V;Ricci C;Virgili G;Salanti G;Germagnoli L;Liberati A;Banfi G
探讨老年髋部骨折手术延迟与死亡率的关系。1948年至2011年发表的回顾性和前瞻性研究的系统综述和荟萃分析。Medline（自1948年起）、Embase（自1974年起）和CINAHL（自1982年起）以及科克伦图书馆。提取每项研究的比值比（OR）和95%置信区间，并使用随机效应模型合并。进行异质性、发表偏倚、贝叶斯分析和荟萃回归分析。入选标准为回顾性和前瞻性老年人群研究、髋关节骨折手术患者、手术时机适应症和生存状态。共有35项独立研究，191，873名参与者和34，448例死亡。大多数人认为截止时间在24至48小时之间。早期髋关节手术与较低的死亡风险（合并比值比（OR）0.74，95%置信区间（CI）0.67至0.81; P<0.000）和压疮风险（0.48，95% CI 0.38至0.60; P<0.000）相关。调整后的前瞻性研究的荟萃分析得出了类似的结果。贝叶斯概率预测，未来约有20%的研究可能会发现早期手术对降低死亡率无益。混杂因素（例如年龄、性别、数据来源、基线风险、截止点、研究地点、质量和年份）均不能解释研究之间的差异。手术延迟与死亡和压疮风险显著增加相关。应避免保守的时机策略。整形外科服务应确保大多数患者在一两天内接受手术。
To assess the relationship between surgical delay and mortality in elderly patients with hip fracture. Systematic review and meta-analysis of retrospective and prospective studies published from 1948 to 2011. Medline (from 1948), Embase (from 1974) and CINAHL (from 1982), and the Cochrane Library. Odds ratios (OR) and 95% confidence intervals for each study were extracted and pooled with a random effects model. Heterogeneity, publication bias, Bayesian analysis, and meta-regression analyses were done. Criteria for inclusion were retro- and prospective elderly population studies, patients with operated hip fractures, indication of timing of surgery and survival status. There were 35 independent studies, with 191,873 participants and 34,448 deaths. The majority considered a cut-off between 24 and 48 hours. Early hip surgery was associated with a lower risk of death (pooled odds ratio (OR) 0.74, 95% confidence interval (CI) 0.67 to 0.81; P<0.000) and pressure sores (0.48, 95% CI 0.38 to 0.60; P<0.000). Meta-analysis of the adjusted prospective studies gave similar results. The Bayesian probability predicted that about 20% of future studies might find that early surgery is not beneficial for decreasing mortality. None of the confounders (e.g. age, sex, data source, baseline risk, cut-off points, study location, quality and year) explained the differences between studies. Surgical delay is associated with a significant increase in the risk of death and pressure sores. Conservative timing strategies should be avoided. Orthopaedic surgery services should ensure the majority of patients are operated within one or two days.
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影响因子：
4
作者：
Doruk, H;Mas, MR;Kyrdemir, V
通讯作者：
Kyrdemir, V
DOI：
10.1016/0020-1383(92)90037-s
发表时间：
1992-01-01
影响因子：
2.5
作者：
BREDAHL, C;NYHOLM, B;OLESEN, AS
通讯作者：
OLESEN, AS
DOI：
10.1302/0301-620x.85b8.14282
发表时间：
2003-11-01
影响因子：
--
作者：
Dorotka, R;Schoechtner, H;Buchinger, W
通讯作者：
Buchinger, W
影响因子：
7.2
作者：
Elliott, J;Beringer, T;Stevenson, M
通讯作者：
Stevenson, M
DOI：
10.1097/01.blo.0000146743.28925.1c
发表时间：
2004-11-01
影响因子：
4.2
作者：
McGuire, KJ;Bernstein, J;Silber, JH
通讯作者：
Silber, JH