术前准备时间对髋部骨折患者术后死亡率的影响

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术前准备时间对髋部骨折患者术后死亡率的影响

贵州医科大学 麻醉与心脏电生理课题组

翻译：马艳燕  编辑：佟睿  审校：曹莹

背景

术前准备时间对急性髋部骨折(AHF)患者死亡率的影响一直存在争议，关于死亡率从什么时限开始增加的研究也不一致。莫恩达尔的萨尔格伦斯卡大学附属医院建议在24小时内手术，几乎没有时间进行术前优化。然而，在国际上，早期手术的定义从24小时到48小时不等，甚至超过48小时。这项回顾性研究旨在调查术前准备时间与术后30天死亡率之间的关系。

方法

我们收集了2007年1月至2016年12月AHF患者的数据。分析变量包括：年龄、性别、ASA分级、手术方法(假体或骨缝术)、术前准备时间以及术后30天死亡率。主要观察指标是以每组术前准备时间进行分析相关的术后30天死亡率。次要观察指标是以每小时术前准备时间进行分析相关的术后30天死亡率。

结果

我们从符合条件的10844名患者中纳入了9270名患者。平均术前准备时间为19.4小时，术后30天总死亡率为7.6%。校正Cox回归分析显示，术前准备时间大于48h的患者死亡率增加。在每小时分析中，观察到术前准备时间为39小时时死亡率显著增加。与术前准备时间小于24小时的患者相比，术前准备时间大于24小时的患者死亡率没有加。

结论

在AHF患者中，术前准备时间超过39-48小时与死亡率增加有关。在39-48小时前进行手术的患者死亡率没有增加，一些患者即使术前准备时间超过24小时，也可以应用术前优化方案。

原始文献来源：

Kristiansson J, Hagberg E, Nellgård B. The influence of time-to-surgery on mortality after a hip fracture. Acta Anaesthesiol Scand. 2020 Mar;64(3):347-353.

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The influence of time-to-surgery on mortality after a hip fracture

Abstract

Background: The effect of time-to-surgery on mortality in acute hip fracture (AHF) patients has been debated and studies are inconsistent regarding from what time-limit mortality starts to increase. At Sahlgrenska University Hospital/Mölndal, surgery is recommended within 24 hours leaving little time for preoperative optimisation. However, internationally the definition of early surgery varies between 24 to 48 hours and over. This retrospective study was initiated to investigate the relation between time-to-surgery and 30-day mortality.

Methods: Data of AHF-patients from January 2007 through December 2016 was collected. The variables analysed were: age, gender, ASA physical status classification, surgical method (prosthesis or osteosynthesis), and time-to-surgery, along with 30-day mortality. Primary outcome was 30-day mortality related to time-to-surgery divided into groups. Secondary outcome was 30- day mortality related to time-to-surgery analysed hour-by-hour.

Results: From 10,844 eligible patients, 9,270 patients were included into the study. Mean time-to surgery was 19.4 hours and overall 30-day mortality was 7.6%. Adjusted Cox regression analysis revealed an increased mortality rate in patients with time-to-surgery >48h. In the hour-by-hour analysis, significant mortality increase was observed at 39 hours of time-to-surgery. Patients with time-to-surgery >24h did not have increased mortality compared to patients with time-to-surgery <24h.

Conclusion: In AHF-patients, a time-to-surgery exceeding 39-48 hours was associated with increased mortality. Patients with surgeries performed before 39-48 hours did not have increased mortality and this time may, in some patients, be used for optimisation prior surgery even if time to-surgery exceeds 24 hours.