加快髋部骨折手术时间的益处因患者风险特征而异。

IF 1.6 3区 医学 Q3 ORTHOPEDICS
Abhishek Ganta, Lauren A Merrell, Carolyn Herbosa, Kenneth A Egol, Sanjit R Konda
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引用次数: 0

摘要

目的根据患者风险分层,确定哪些髋部骨折患者最受益于在急诊科(ED)就诊后 24 小时内进行手术修复:设计:回顾性队列:方法:设计:回顾性队列:患者选择标准:患者选择标准:接受AO/OTA 31A、31B或32A髋部骨折手术治疗的患者:使用经过验证的风险分层工具(中老年创伤分诊评分工具[STTGMA],该工具经证实可预测创伤患者的住院死亡率)将每位患者划分为 "个体化风险四分位"(IRQ)。患者被分为最小风险、低风险、中度风险和高度风险 IRQ。在每个队列中,根据患者从到达急诊室到手术的时间(< 24 小时、> 24 小时且< 48 小时、> 48 小时)将患者分为三组。对这 12 组患者的并发症(轻微住院并发症包括急性肾损伤、尿路感染、褥疮和急性失血性贫血,主要住院并发症包括败血症或脓毒性休克、肺炎、急性呼吸衰竭、中风、心肌梗死、心脏骤停、深静脉血栓或肺栓塞)、死亡率和医院质量指标(住院时间和再入院率)进行了分析。结果在不同组群之间进行了比较:共确认了 2472 名患者:队列的平均年龄为(80.6 ± 10.3)岁,主要为女性(69%)和白人(71%)。数据显示,与24小时至48小时之间的手术和超过48小时的手术相比,所有患者(无风险分层)在24小时内进行手术的结果(并发症、死亡率、医院质量指标)均有所改善(所有结果均为 "无风险分层"):这项研究表明,按风险分层后,加快手术时间对患者的影响有所不同。与24小时内手术相比,风险最低的髋部骨折患者在48小时内手术的效果并不差:证据等级:III。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Benefit of Expedited Time to Hip Fracture Surgery Differs Based on Patient Risk Profile.

Objectives: To identify which hip fracture patients benefit the most from operative repair within 24 hours of Emergency Department presentation based on patient risk stratification.

Methods:

Design: Retrospective Cohort.

Setting: Academic Medical Center.

Patient selection criteria: Patients operatively treated for an AO/OTA 31 A, 31 B, or 32 A hip fracture.

Outcome measures and comparisons: Each patient was placed into an "individualized risk quartile" (Individual Risk Quartile) using a validated risk stratification tool (The Score for Trauma Triage in the Geriatric and Middle-Aged [Score for Trauma Triage and Geriatric Middle Aged], a tool proven to predict inpatient mortality in trauma patients). Patients were risk stratified into minimal-, low-, moderate-, and high-risk IRQs. In each cohort, patients were separated into 3 groups based on their time from Emergency Department arrival to surgery (<24 hours, >24 hours and <48 hours, and >48 hours). Each of these 12 groups was analyzed for complications (minor inpatient complications included acute kidney injury, urinary tract infection, decubitus ulcer, and acute blood loss anemia, while major inpatient complications included sepsis or septic shock, pneumonia, acute respiratory failure, stroke, myocardial infarction, cardiac arrest, and deep vein thrombosis or pulmonary embolism), mortality rates, and hospital quality measures (length of stay and readmission rates). The results were compared across cohorts.

Results: A total of 2472 patients were identified: the mean age of the cohort was 80.6 ± 10.3 and was predominantly female (69%) and white (71%). The data demonstrated improved outcomes (complications, mortality rates, hospital quality measures) across all patients (nonrisk stratified) for surgery within 24 hours compared with surgery between 24 hours and 48 hours and surgery greater than 48 hours (all outcomes P < 0.050). However, these effects were not evenly distributed among the IRQs. In the IRQ4 cohort, major complication rates progressed from 20% to 25% to 34% as a function of time to surgery ( P = 0.007). IRQ1 did not demonstrate similar results ( P = 0.756), with the rates essentially static across surgery time points (3%-2% to 4%). A similar trend was seen when analyzing mortality at 1 year for highest risk patients, with similar 1-year mortality rates across operating room windows of IRQs 1-3 (IRQ1: P = 0.061, IRQ2: P = 0.259, IRQ3: P = 0.524) but increased in IRQ4 with increasing time to surgery (21% vs. 33% vs. 33%, P = 0.006).

Conclusions: This study demonstrates a differential impact of expedited time to surgery on patients when stratified by the risk profile. The lowest risk hip fracture patients do not fare worse if operated on within 48 hours as compared to 24 hours.

Level of evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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来源期刊
Journal of Orthopaedic Trauma
Journal of Orthopaedic Trauma 医学-运动科学
CiteScore
3.90
自引率
8.70%
发文量
396
审稿时长
3-8 weeks
期刊介绍: Journal of Orthopaedic Trauma is devoted exclusively to the diagnosis and management of hard and soft tissue trauma, including injuries to bone, muscle, ligament, and tendons, as well as spinal cord injuries. Under the guidance of a distinguished international board of editors, the journal provides the most current information on diagnostic techniques, new and improved surgical instruments and procedures, surgical implants and prosthetic devices, bioplastics and biometals; and physical therapy and rehabilitation.
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