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首页> 外文期刊>The Journal of Bone and Joint Surgery. American Volume >Patient risk factors, operative care, and outcomes among older community-dwelling male veterans with hip fracture.
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Patient risk factors, operative care, and outcomes among older community-dwelling male veterans with hip fracture.

机译：患者的危险因素，手术护理和髋关节骨折的社区老年男性退伍军人的结局。

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BACKGROUND: Although more than 1200 hip fracture repairs are performed in United States Department of Veterans Affairs hospitals annually, little is known about the relationship between perioperative care and short-term outcomes for veterans with hip fracture. The purpose of the present study was to test whether perioperative care impacts thirty-day outcomes, with patient characteristics being taken into account. METHODS: A national sample of 5683 community-dwelling male veterans with an age of sixty-five years or older who had been hospitalized for the operative treatment of a hip fracture at one of 108 Veterans Administration hospitals between 1998 and 2003 was identified from the National Surgical Quality Improvement Program data set. Operative care characteristics were assessed in relation to thirty-day outcomes (mortality, complications, and readmission to a Veterans Administration facility for inpatient care). RESULTS: A surgical delay of four days or more after admission was associated with a higher adjusted mortality risk (odds ratio, 1.29; 95% confidence interval, 1.02 to 1.61) but a reduced risk of readmission (odds ratio, 0.70; 95% confidence interval, 0.54 to 0.91). Compared with spinal or epidural anesthesia, general anesthesia was related to a significantly higher risk of both mortality (odds ratio, 1.27; 95% confidence interval, 1.01 to 1.55) and complications (odds ratio, 1.33; 95% confidence interval, 1.15 to 1.53). The type of procedure was not significantly associated with outcome after controlling for other variables in the model. However, a higher American Society of Anesthesiologists Physical Status Classification (ASA class) was associated with worse thirty-day outcomes. CONCLUSIONS: In addition to recognizing the importance of patient-related factors, we identified operative factors that were related to thirty-day surgical outcomes. It will be important to investigate whether modifying operative factors, such as reducing surgical delays to less than four days, can directly improvethe outcomes of hip fracture repair.
机译：背景：尽管美国退伍军人事务部医院每年进行1200多次髋部骨折修复，但对于髋部骨折退伍军人的围手术期护理与短期预后之间的关系知之甚少。本研究的目的是在考虑患者特征的情况下测试围手术期护理是否会影响30天结局。方法：从美国国家医学会（National National）的全国样本中，对1998年至2003年间在108家退伍军人管理局医院中接受手术治疗髋部骨折的年龄在65岁以上的5683岁社区男性退伍军人进行抽样调查。手术质量改善计划数据集。评估了与30天结局（死亡率，并发症和退伍军人管理局设施的住院治疗）相关的手术护理特征。结果：入院后手术延迟四天或更长时间与更高的调整后死亡风险（赔率，1.29; 95％置信区间，1.02至1.61）相关，但再次入院的风险降低（赔率，0.70; 95％置信度）区间0.54到0.91）。与脊柱或硬膜外麻醉相比，全身麻醉与死亡率（优势比，1.27; 95％置信区间，1.01至1.55）和并发症（优势比，1.33; 95％置信区间，1.15至1.53）均显着较高）。在控制模型中的其他变量之后，程序的类型与结果没有显着相关。但是，较高的美国麻醉医师学会身体状况分类（ASA等级）与30天的预后差有关。结论：除了认识到患者相关因素的重要性外，我们还确定了与30天手术结局相关的手术因素。研究修改手术因素（例如将手术延迟减少至不到四天）是否可以直接改善髋部骨折修复的结果，这一点很重要。

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