{"title":"使用直接前路入路治疗老年人群股骨颈骨折后，熟练护理机构入院人数减少。","authors":"Devon R Pekas, Daniel Griffin, Trevor M Owen","doi":"10.1097/BOT.0000000000003076","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>To investigate the effect surgical approach has on discharge disposition following hip hemiarthroplasty (HHA) treatment of femoral neck fractures (FNF) in the geriatric population.</p><p><strong>Methods: </strong>Design: Retrospective comparative cohort.</p><p><strong>Setting: </strong>Level 1 trauma center.</p><p><strong>Patient selection criteria: </strong>Patients 65 years old and older who had a FNF (OTA/AO 31-B) treated with a HHA via the anterolateral approach (ALA), direct anterior approach (DAA), or posterolateral approach (PLA) between 2/1/2017 and 2/1/2021.</p><p><strong>Outcome measures and comparisons: </strong>Demographics, discharge disposition, operative timing, inpatient outcomes, and postoperative complications were measured. Outcomes were compared with PLA differentiated into PLA1 and PLA2 to correspond with the time periods that ALA and DAA were performed, respectively.</p><p><strong>Results: </strong>277 patients (34 ALA, 101 PLA1, 38 DAA, and 104 PLA2) were included. Patients' age (ALA=79.1 vs. PLA1=78.4 vs. DAA=80.4 vs. PLA2=81.1 years; p = 0.069), sex (ALA=82.4% vs. PLA1=70.3% vs. DAA=71.1% vs. PLA2=75.0%; p = 0.517), and ASA score (ALA=3.1 vs. PLA1=3.1 vs. DAA=3.0 vs. PLA2=3.0; p = 0.953) were similar. Operative time (ALA=72.3 vs. PLA1=74.6 vs. DAA=79.3 vs. PLA2=73.7 minutes; p = 0.232), transfusion rate (ALA=0.0% vs. PLA1=8.0% vs. DAA=5.3% vs. PLA2=4.8%; p = 0.345), 30-day readmission rate (ALA=5.9% vs. PLA1=5.9% vs. DAA=15.8% vs. PLA2=8.7%; p = 0.289), 1-year reoperation rate (ALA=2.9% vs. PLA1=1.0% vs. DAA=0.0% vs. PLA2=3.8%; p = 0.393), and 1-year mortality (ALA=20.6% vs. PLA1=26.7% vs. DAA=31.6% vs. PLA2=30.8%; p = 0.635) were similar. Discharge rates to a skilled nursing facility (SNF) were significantly lower for DAA when compared to ALA (71.1% and 94.1%; p = 0.021).</p><p><strong>Conclusions: </strong>Treatment of FNF with HHA via the DAA resulted in a significantly lower rate of disposition to SNF compared to ALA.</p><p><strong>Level of evidence: </strong>Therapeutic Level III.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.8000,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Diminished Admission to Skilled Nursing Facility Following the Use of Direct Anterior Approach for Treating Femoral Neck Fractures in a Geriatric Population.\",\"authors\":\"Devon R Pekas, Daniel Griffin, Trevor M Owen\",\"doi\":\"10.1097/BOT.0000000000003076\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>To investigate the effect surgical approach has on discharge disposition following hip hemiarthroplasty (HHA) treatment of femoral neck fractures (FNF) in the geriatric population.</p><p><strong>Methods: </strong>Design: Retrospective comparative cohort.</p><p><strong>Setting: </strong>Level 1 trauma center.</p><p><strong>Patient selection criteria: </strong>Patients 65 years old and older who had a FNF (OTA/AO 31-B) treated with a HHA via the anterolateral approach (ALA), direct anterior approach (DAA), or posterolateral approach (PLA) between 2/1/2017 and 2/1/2021.</p><p><strong>Outcome measures and comparisons: </strong>Demographics, discharge disposition, operative timing, inpatient outcomes, and postoperative complications were measured. Outcomes were compared with PLA differentiated into PLA1 and PLA2 to correspond with the time periods that ALA and DAA were performed, respectively.</p><p><strong>Results: </strong>277 patients (34 ALA, 101 PLA1, 38 DAA, and 104 PLA2) were included. Patients' age (ALA=79.1 vs. PLA1=78.4 vs. DAA=80.4 vs. PLA2=81.1 years; p = 0.069), sex (ALA=82.4% vs. PLA1=70.3% vs. DAA=71.1% vs. PLA2=75.0%; p = 0.517), and ASA score (ALA=3.1 vs. PLA1=3.1 vs. DAA=3.0 vs. PLA2=3.0; p = 0.953) were similar. Operative time (ALA=72.3 vs. PLA1=74.6 vs. DAA=79.3 vs. PLA2=73.7 minutes; p = 0.232), transfusion rate (ALA=0.0% vs. PLA1=8.0% vs. DAA=5.3% vs. PLA2=4.8%; p = 0.345), 30-day readmission rate (ALA=5.9% vs. PLA1=5.9% vs. DAA=15.8% vs. PLA2=8.7%; p = 0.289), 1-year reoperation rate (ALA=2.9% vs. PLA1=1.0% vs. DAA=0.0% vs. PLA2=3.8%; p = 0.393), and 1-year mortality (ALA=20.6% vs. PLA1=26.7% vs. DAA=31.6% vs. PLA2=30.8%; p = 0.635) were similar. Discharge rates to a skilled nursing facility (SNF) were significantly lower for DAA when compared to ALA (71.1% and 94.1%; p = 0.021).</p><p><strong>Conclusions: </strong>Treatment of FNF with HHA via the DAA resulted in a significantly lower rate of disposition to SNF compared to ALA.</p><p><strong>Level of evidence: </strong>Therapeutic Level III.</p>\",\"PeriodicalId\":16644,\"journal\":{\"name\":\"Journal of Orthopaedic Trauma\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":1.8000,\"publicationDate\":\"2025-09-19\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Orthopaedic Trauma\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/BOT.0000000000003076\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Orthopaedic Trauma","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/BOT.0000000000003076","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0
摘要
目的：探讨手术入路对老年人群股骨颈骨折（FNF）半髋关节置换术（HHA）术后出院倾向的影响。方法：设计：回顾性比较队列。地点：一级创伤中心。患者选择标准：在2017年2月1日至2021年2月1日期间，65岁及以上的FNF （OTA/AO 31-B）患者通过前外侧入路（ALA）、直接前路（DAA）或后外侧入路（PLA）接受HHA治疗。结果测量和比较：测量了人口统计学、出院处置、手术时机、住院结果和术后并发症。将PLA分化为PLA1和PLA2的结果与分别进行ALA和DAA的时间相比较。结果：纳入277例患者（ALA 34例，PLA1 101例，DAA 38例，PLA2 104例）。患者年龄（ALA=79.1 vs. PLA1=78.4 vs. DAA=80.4 vs. PLA2=81.1岁；p = 0.069）、性别（ALA=82.4% vs. PLA1=70.3% vs. DAA=71.1% vs. PLA2=75.0%; p = 0.517）、ASA评分（ALA=3.1 vs. PLA1=3.1 vs. DAA=3.0 vs. PLA2=3.0; p = 0.953）相似。手术时间（ALA=72.3 vs. PLA1=74.6 vs. DAA=79.3 vs. PLA2=73.7分钟；p = 0.232）、输血率（ALA=0.0% vs. PLA1=8.0% vs. DAA=5.3% vs. PLA2=4.8%; p = 0.345）、30天再入院率（ALA=5.9% vs. PLA1=5.9% vs. DAA=15.8% vs. PLA2=8.7%; p = 0.289）、1年再手术率（ALA=2.9% vs. PLA1=1.0% vs. DAA=0.0% vs. PLA2=3.8%; p = 0.393）、1年死亡率（ALA=20.6% vs. PLA1=26.7% vs. DAA=31.6% vs. PLA2=30.8%; p = 0.635）相似。与ALA相比，DAA到熟练护理机构（SNF）的出院率显著降低（71.1%和94.1%;p = 0.021）。结论：与ALA相比，通过DAA用HHA治疗FNF可显著降低SNF处置率。证据等级：治疗性III级。
Diminished Admission to Skilled Nursing Facility Following the Use of Direct Anterior Approach for Treating Femoral Neck Fractures in a Geriatric Population.
Objectives: To investigate the effect surgical approach has on discharge disposition following hip hemiarthroplasty (HHA) treatment of femoral neck fractures (FNF) in the geriatric population.
Patient selection criteria: Patients 65 years old and older who had a FNF (OTA/AO 31-B) treated with a HHA via the anterolateral approach (ALA), direct anterior approach (DAA), or posterolateral approach (PLA) between 2/1/2017 and 2/1/2021.
Outcome measures and comparisons: Demographics, discharge disposition, operative timing, inpatient outcomes, and postoperative complications were measured. Outcomes were compared with PLA differentiated into PLA1 and PLA2 to correspond with the time periods that ALA and DAA were performed, respectively.
Results: 277 patients (34 ALA, 101 PLA1, 38 DAA, and 104 PLA2) were included. Patients' age (ALA=79.1 vs. PLA1=78.4 vs. DAA=80.4 vs. PLA2=81.1 years; p = 0.069), sex (ALA=82.4% vs. PLA1=70.3% vs. DAA=71.1% vs. PLA2=75.0%; p = 0.517), and ASA score (ALA=3.1 vs. PLA1=3.1 vs. DAA=3.0 vs. PLA2=3.0; p = 0.953) were similar. Operative time (ALA=72.3 vs. PLA1=74.6 vs. DAA=79.3 vs. PLA2=73.7 minutes; p = 0.232), transfusion rate (ALA=0.0% vs. PLA1=8.0% vs. DAA=5.3% vs. PLA2=4.8%; p = 0.345), 30-day readmission rate (ALA=5.9% vs. PLA1=5.9% vs. DAA=15.8% vs. PLA2=8.7%; p = 0.289), 1-year reoperation rate (ALA=2.9% vs. PLA1=1.0% vs. DAA=0.0% vs. PLA2=3.8%; p = 0.393), and 1-year mortality (ALA=20.6% vs. PLA1=26.7% vs. DAA=31.6% vs. PLA2=30.8%; p = 0.635) were similar. Discharge rates to a skilled nursing facility (SNF) were significantly lower for DAA when compared to ALA (71.1% and 94.1%; p = 0.021).
Conclusions: Treatment of FNF with HHA via the DAA resulted in a significantly lower rate of disposition to SNF compared to ALA.
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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