Influence of operative timing on postoperative complications and prognosis of hip fracture in the elderly
Jiang Luoyong1, Yue Jiaji1, He Qifei1, You Wei1, Xie Wei1, He Jinglong1, Cui Manli2, Ding Qiang1, Wang Manyi1, Sun Wei1
1Department of Orthopaedics, Shenzhen Second People's Hospital (the First Affiliated Hospital of Shenzhen University), Shenzhen 518000, China; 2Department of Geriatrics, Shenzhen Second People's Hospital (the First Affiliated Hospital of Shenzhen University), Shenzhen 518000, China
Abstract：Objective This study aims to explore the effect of different operation times on postoperative complications and prognosis of elderly patients with hip fracture.Methods A retrospective cohort study was conducted. From January to December 2020, 249 elderly patients with hip fracture in the Department of Orthopedics of Shenzhen Second People's Hospital were included. The participants included 92 males and 157 females aged ranging from 65 to 101 (80.0±8.5) years. A total of 154 cases had femoral neck fracture and 95 cases had intertrochanteric fracture. All 249 patients underwent surgical treatment, including 84 cases of closed reduction and internal fixation with proximal femoral anti rotation nail, 1 case of internal fixation with femoral neck dynamic cross nail system, 71 cases of artificial femoral head replacement, and 93 cases of total hip replacement. The patients were divided into three groups according to the time from admission to surgery. The time from admission to surgery ≤24 h was the early group (57 cases), the time from admission to surgery >24-48 h was the delayed group (95 cases), and the time from admission to surgery >48 h was the late group (97 cases). The clinical baseline data of the three groups were compared, including the transfer rate of surgical intensive care unit (ICU), stay time in ICU, hospital stay, and incidence of pulmonary infection, urinary system infection, lower extremity deep vein thrombosis, delirium, stress ulcer, anemia, hypoproteinemia, pressure ulcer, incision infection, and other complications. Harris score was used to evaluate the hip joint function at 1 and 3 months after the operation, and mortality was observed at 1 month and 1 year after the operation to evaluate prognosis. Postoperative efficacy and prognosis were compared among the three groups.Results No significant differences in the three groups were found in terms of gender, age, fracture site, fracture type, medical complications, American Society of Anesthesiologists classification, operation method, and other baseline data (all P values >0.05). The hospital stay and ICU transfer rate of patients in the early stage group were (9.4±4.2) d and 1.8%(1/57), respectively, while those in the delayed stage group were (10.7±5.5) d and 4.2%(4/95), which were significantly lower than those in the late stage group (12.8±6.3)d and 11.3%(11/97), respectively (all P values <0.05). However, the ICU indwelling time was not significantly different among the three groups (P>0.05). Moreover, postoperative complications such as pressure sore, incision infection, urinary system infection, anemia, and hypoproteinemia were not significantly different among the three groups (all P values >0.05). The incidence of postoperative complications such as pulmonary infection, deep vein thrombosis, stress ulcer and postoperative delirium was the lowest in the early group, followed by the delayed group and the highest in the late group, and the differences were statistically significant (all P values <0.05). The Harris score at 1 month after the operation was the highest in the early group, followed by the delayed group and the lowest in the late group. The 1-year postoperative mortality was the lowest in the early group, followed by the delayed group and the highest in the late group, and the differences were statistically significant (all P values <0.05). However, no significant difference was found in Harris score at 3 months after the operation and mortality at 1 month after the operation (all P values >0.05).Conclusion Patients with elderly hip fracture are recommended to operate as early as possible after injury, and the best time from admission to operation should be controlled within 24 hours. The time from admission to operation <48 h can reduce the incidence of postoperative complications, reduce the mortality within 1 year after the operation, shorten the length of hospital stay, and facilitate the early recovery of hip function.
姜骆永, 岳家吉, 何琦非, 尤微, 谢伟, 贺敬龙, 崔曼丽, 丁强, 王满宜, 孙炜. 老年人髋部骨折手术时机对术后并发症及预后的影响[J]. 中华解剖与临床杂志, 2023, 28(1): 21-26.
Jiang Luoyong, Yue Jiaji, He Qifei, You Wei, Xie Wei, He Jinglong, Cui Manli, Ding Qiang, Wang Manyi, Sun Wei. Influence of operative timing on postoperative complications and prognosis of hip fracture in the elderly. Chinese Journal of Anatomy and Clinics, 2023, 28(1): 21-26.
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