Factors preventing early surgery for hip fractures in elderly patients: The osteoporosis liaison service (OLS)-Kashiwa study.

IF 2.8 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM
Yukihiro Kokubu, Aya Obi, Yuka Kimura, Aya Hattori, Hisanori Nemoto, Yujiro Matsuda, Yuho Oki, Ryo Amamiya, Keita Ogine, Masaru Misawa, Tomoko Shimaoka, Keisuke Hirose, Yoshiaki Ando, Toshinori Kurashige, Kiyoma Marusugi, Shuichi Kaneyama, Hiroshi Kawaguchi
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引用次数: 0

Abstract

Despite a recent reimbursement policy promoting early surgery for hip fractures in Japan, more than half of elderly patients experienced delays. Referral refusals, weekend admissions, comorbidity-related evaluations, and arthroplasty were key predictors. System-level reforms are needed to improve timely surgical access in Japan's aging population.

Purpose: To identify pre-admission and post-admission factors associated with surgical delays for hip fractures in elderly patients, despite the recent implementation of the Japanese Ministry of Health, Labour and Welfare (MHLW) reimbursement policy incentivizing early surgery within 48 h.

Methods: This retrospective cohort study included 366 patients aged ≥ 75 years who underwent surgery for hip fractures at a single acute-care hospital between January 2022 and December 2023. Patients were classified into early surgery (≤ 48 h) and delayed surgery (> 48 h) groups. Time to surgery was divided into pre-admission and post-admission intervals. Variables analyzed included age, sex, residence, referral refusal, admission day of the week, preoperative multi-specialty consultation, anticoagulant use, fracture type, and surgical procedure. Multivariate logistic regression identified independent predictors of delay.

Results: Of all patients, 48.9% underwent early surgery. The delayed group had significantly longer pre- and post-admission times. Four factors were independently associated with delay: referral refusal (p = 0.027), admission later in the week (p = 0.004), preoperative multi-specialty consultation (p = 0.001), and arthroplasty rather than internal fixation (p = 0.028). In contrast, age, sex, residence, fracture type, and anticoagulant use were not significantly associated. Postoperative hospital stay was paradoxically longer in the early surgery group, primarily due to differences in discharge readiness between nursing home residents and community dwellers.

Conclusion: Despite financial incentives, surgical delays persist due to both pre- and post-admission factors. System-level reforms-including improved referral systems, coordinated weekend surgical access, streamlined workflows, and adequate implant availability-are needed to enhance the effectiveness of early surgery initiatives in Japan's aging population.

预防老年患者髋部骨折早期手术的因素:骨质疏松联络服务(OLS)-Kashiwa研究。
尽管日本最近出台了一项促进髋部骨折早期手术的报销政策,但超过一半的老年患者经历了延迟手术。转诊拒绝、周末入院、合并症相关评估和关节置换术是关键的预测因素。需要进行系统层面的改革,以改善日本老龄化人口及时接受手术的机会。目的:确定入院前和入院后与老年髋部骨折手术延迟相关的因素,尽管最近日本厚生劳动省(MHLW)的报销政策鼓励患者在48小时内进行早期手术。方法:这项回顾性队列研究包括366名年龄≥75岁的患者,他们于2022年1月至2023年12月在一家急性护理医院接受髋部骨折手术。将患者分为早期手术组(≤48 h)和延迟手术组(> 48 h)。手术时间分为入院前和入院后。分析的变量包括年龄、性别、居住地、拒绝转诊、入院日期、术前多专科会诊、抗凝剂使用、骨折类型和手术方式。多元逻辑回归确定了延迟的独立预测因子。结果:48.9%的患者接受了早期手术。延迟组在入院前和入院后的时间明显更长。4个因素与延迟独立相关:拒绝转诊(p = 0.027)、周后入院(p = 0.004)、术前多专科会诊(p = 0.001)和关节置换术而非内固定(p = 0.028)。相反,年龄、性别、居住地、骨折类型和抗凝剂使用无显著相关。在早期手术组中,术后住院时间反而更长,这主要是由于养老院居民和社区居民在出院准备方面的差异。结论:尽管有经济激励,但由于入院前和入院后的因素,手术延误仍然存在。系统层面的改革——包括改进转诊系统、协调周末手术、简化工作流程和充足的植入物供应——需要提高日本老龄化人口早期手术举措的有效性。
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来源期刊
Archives of Osteoporosis
Archives of Osteoporosis ENDOCRINOLOGY & METABOLISMORTHOPEDICS -ORTHOPEDICS
CiteScore
5.50
自引率
10.00%
发文量
133
期刊介绍: Archives of Osteoporosis is an international multidisciplinary journal which is a joint initiative of the International Osteoporosis Foundation and the National Osteoporosis Foundation of the USA. The journal will highlight the specificities of different regions around the world concerning epidemiology, reference values for bone density and bone metabolism, as well as clinical aspects of osteoporosis and other bone diseases.
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