Hanne-Eva van Bremen, Lotta J Seppala, Johannes H Hegeman, Nathalie van der Velde, Hanna C Willems
{"title":"利用荷兰髋部骨折审计（DHFA）研究非手术治疗的髋部骨折患者的特征和疗效。","authors":"Hanne-Eva van Bremen, Lotta J Seppala, Johannes H Hegeman, Nathalie van der Velde, Hanna C Willems","doi":"10.1097/BOT.0000000000002778","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>To identify and compare characteristics of patients with hip fracture treated nonoperatively versus those treated operatively.</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Hip fracture population-based study.</p><p><strong>Patient selection criteria: </strong>All adult patients with hip fractures (OTA/AO 31A and 31B) were included. Patients with pathological or periprosthetic hip fractures were excluded.</p><p><strong>Outcome measures and comparisons: </strong>Patients were categorized according to the type of management (operative vs. nonoperative) and type of fracture (nondisplaced vs. other). Patient and fracture characteristics associated with nonoperative management (NOM) were analyzed.</p><p><strong>Results: </strong>A total of 94,930 patients with hip fracture were included. Of these, 3.2% were treated nonoperatively. Patients receiving NOM were older [86 years (interquartile range, 79-91 years) vs. 81 years (interquartile range, 72-87 years); P < 0.001], more frequently institutionalized (42.4% vs. 17.6%), and were more dependent in activities of daily living (22.2% vs. 55.0%). Various clinical characteristics, including dementia [odds ratio (OR) 1.31 (95% confidence interval, CI, 1.18-1.45) P < 0.001], no functional mobility [OR 4.39 (95% CI, 3.14-3.68) P < 0.001], and activities of daily living (ADL) measured as KATZ-6-ADL [OR 1.17 (95% CI, 1.14-1.20) P < 0.001] were independently associated with NOM. Seven-day mortality was 37.6%, and 30-day mortality was 57.1% in patients treated nonoperatively.</p><p><strong>Conclusions: </strong>The first step in understanding patients who potentially benefit from NOM is evaluating the current standard of care. This study provides insight into the current hip fracture population treated nonoperatively. These patients are older, have higher percentage of dementia, more dependent, and show higher short-term mortality rates.</p><p><strong>Level of evidence: </strong>Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":null,"pages":null},"PeriodicalIF":1.6000,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11017835/pdf/","citationCount":"0","resultStr":"{\"title\":\"Characteristics and Outcomes of Nonoperatively Managed Patients With Hip Fracture Using the Dutch Hip Fracture Audit.\",\"authors\":\"Hanne-Eva van Bremen, Lotta J Seppala, Johannes H Hegeman, Nathalie van der Velde, Hanna C Willems\",\"doi\":\"10.1097/BOT.0000000000002778\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>To identify and compare characteristics of patients with hip fracture treated nonoperatively versus those treated operatively.</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Hip fracture population-based study.</p><p><strong>Patient selection criteria: </strong>All adult patients with hip fractures (OTA/AO 31A and 31B) were included. Patients with pathological or periprosthetic hip fractures were excluded.</p><p><strong>Outcome measures and comparisons: </strong>Patients were categorized according to the type of management (operative vs. nonoperative) and type of fracture (nondisplaced vs. other). Patient and fracture characteristics associated with nonoperative management (NOM) were analyzed.</p><p><strong>Results: </strong>A total of 94,930 patients with hip fracture were included. Of these, 3.2% were treated nonoperatively. Patients receiving NOM were older [86 years (interquartile range, 79-91 years) vs. 81 years (interquartile range, 72-87 years); P < 0.001], more frequently institutionalized (42.4% vs. 17.6%), and were more dependent in activities of daily living (22.2% vs. 55.0%). Various clinical characteristics, including dementia [odds ratio (OR) 1.31 (95% confidence interval, CI, 1.18-1.45) P < 0.001], no functional mobility [OR 4.39 (95% CI, 3.14-3.68) P < 0.001], and activities of daily living (ADL) measured as KATZ-6-ADL [OR 1.17 (95% CI, 1.14-1.20) P < 0.001] were independently associated with NOM. Seven-day mortality was 37.6%, and 30-day mortality was 57.1% in patients treated nonoperatively.</p><p><strong>Conclusions: </strong>The first step in understanding patients who potentially benefit from NOM is evaluating the current standard of care. This study provides insight into the current hip fracture population treated nonoperatively. These patients are older, have higher percentage of dementia, more dependent, and show higher short-term mortality rates.</p><p><strong>Level of evidence: </strong>Therapeutic Level III. 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引用次数: 0
摘要
目的：本研究旨在确定和比较非手术治疗与手术治疗髋部骨折患者的特征：本研究旨在确定和比较非手术治疗与手术治疗的髋部骨折患者的特征：设计：回顾性队列研究：设计：回顾性队列研究：患者选择标准：纳入所有髋部骨折（OTA/AO 31A和31B）成年患者。排除病理性或假体周围性髋部骨折患者：根据处理方式（手术与非手术）和骨折类型（非置换与其他）对患者进行分类。分析了与非手术治疗相关的患者和骨折特征：结果：共纳入 94 930 名髋部骨折患者。结果：共纳入 94 930 名髋部骨折患者，其中 3.2% 的患者接受了非手术治疗。接受非手术治疗的患者年龄较大（86 岁[四分位数间距 79-91] vs 81 岁[四分位数间距 72-87] P 结论：要了解哪些患者可能从非手术治疗中获益，首先要评估目前的治疗标准。本研究对目前接受非手术治疗的髋部骨折患者进行了深入了解。这些患者年龄较大，痴呆比例较高，依赖性较强，短期死亡率较高：证据等级：治疗三级。有关证据级别的完整描述，请参阅 "作者须知"。
Characteristics and Outcomes of Nonoperatively Managed Patients With Hip Fracture Using the Dutch Hip Fracture Audit.
Objectives: To identify and compare characteristics of patients with hip fracture treated nonoperatively versus those treated operatively.
Methods:
Design: Retrospective cohort study.
Setting: Hip fracture population-based study.
Patient selection criteria: All adult patients with hip fractures (OTA/AO 31A and 31B) were included. Patients with pathological or periprosthetic hip fractures were excluded.
Outcome measures and comparisons: Patients were categorized according to the type of management (operative vs. nonoperative) and type of fracture (nondisplaced vs. other). Patient and fracture characteristics associated with nonoperative management (NOM) were analyzed.
Results: A total of 94,930 patients with hip fracture were included. Of these, 3.2% were treated nonoperatively. Patients receiving NOM were older [86 years (interquartile range, 79-91 years) vs. 81 years (interquartile range, 72-87 years); P < 0.001], more frequently institutionalized (42.4% vs. 17.6%), and were more dependent in activities of daily living (22.2% vs. 55.0%). Various clinical characteristics, including dementia [odds ratio (OR) 1.31 (95% confidence interval, CI, 1.18-1.45) P < 0.001], no functional mobility [OR 4.39 (95% CI, 3.14-3.68) P < 0.001], and activities of daily living (ADL) measured as KATZ-6-ADL [OR 1.17 (95% CI, 1.14-1.20) P < 0.001] were independently associated with NOM. Seven-day mortality was 37.6%, and 30-day mortality was 57.1% in patients treated nonoperatively.
Conclusions: The first step in understanding patients who potentially benefit from NOM is evaluating the current standard of care. This study provides insight into the current hip fracture population treated nonoperatively. These patients are older, have higher percentage of dementia, more dependent, and show higher short-term mortality rates.
Level of evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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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