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Early and ultra-early surgery in hip fracture patients improves survival

机译：髋部骨折患者的早期和超早期手术可提高生存率

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Background: Hip fracture is a common injury with associated high mortality. Recent drives by the Department of Health have sought to prioritise these patients' care. In April 2010, the Best Practice Tariff was introduced in England and Wales. This offers financial incentives to institutions that provide holistic care and surgery within 36 h for hip fracture patients. The England and Wales National Institute for Health and Clinical Excellence (NICE) published its first guidance on hip fracture management in June 2011, and emphasised the need for surgery on the day or day after admission. In spite of the emphasis placed on this injury, the predictors of in-hospital mortality remain ill-defined. In particular the effect of the timing of surgery remains contentious. Objective: To address the issues raised by NICE around surgical timing and examine whether surgery before a 36 h watershed improves survival. In addition, to examine survival outcomes for each 12 h watershed following admission. Materials and methods: Prospectively collected data on 2056 patients presenting to our unit with hip fractures between February 2008 and May 2011 were retrospectively reviewed. Multivariate regression analysis was used to correct for confounders, and so determine the effect of various parameters on in-patient mortality. Results: Age (p < 0.0001), male-gender (p < 0.0001), source of admission (p < 0.05), ASA-grade (p < 0.0001) and delay of surgery (p < 0.01) were associated with an increased risk of in-hospital mortality. The adjusted odds of in-hospital mortality were 1.58 (p < 0.05) times higher in those undergoing surgery after 36 h compared to surgery before this time. Early surgery (within 24 h) resulted in reduced in-hospital mortality when compared to the 36 h watershed. Similarly ultra-early surgery (within 12 h) was even better still (adjusted odds ratio 3.9 p < 0.05). Conclusions: Expeditious surgery is associated with improved patient survival. Other predictors of in-hospital mortality include age, gender, in-hospital fracture and ASA-grade. Ultra-early surgery (within 12 h) reduces risk of in-hospital mortality.
机译：背景：髋部骨折是常见的损伤，伴有较高的死亡率。卫生部最近的努力寻求优先考虑这些患者的护理。 2010年4月，最佳实践关税在英格兰和威尔士推出。这为那些在36小时内为髋部骨折患者提供整体护理和手术的机构提供了经济激励。英格兰和威尔士国家卫生与临床卓越研究所（NICE）于2011年6月发布了有关髋部骨折管理的首份指南，并强调入院后第二天或第二天必须进行手术。尽管重点放在这种损伤上，但院内死亡率的预测因子仍然不确定。特别是手术时机的影响仍然存在争议。目的：解决NICE在手术时机方面提出的问题，并检查在36小时的分水岭之前进行手术是否可以提高生存率。此外，检查入院后每12小时流域的生存结果。材料和方法：回顾性收集了2008年2月至2011年5月间在我科就诊的2056例髋部骨折患者的数据。使用多元回归分析校正混杂因素，从而确定各种参数对住院死亡率的影响。结果：年龄（p <0.0001），男性（p <0.0001），入院来源（p <0.05），ASA级（p <0.0001）和手术延迟（p <0.01）与患病风险增加相关住院死亡率与该时间之前的手术相比，在36 h之后进行手术的患者的住院死亡率调整后的几率高1.58倍（p <0.05）。与36小时的分水岭相比，早期手术（24小时内）可降低院内死亡率。同样，超早期手术（12小时内）甚至更好（调整后的优势比3.9 p <0.05）。结论：迅速手术与患者生存期延长有关。院内死亡率的其他预测指标包括年龄，性别，院内骨折和ASA级。超早期手术（12小时内）可降低院内死亡的风险。

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