以色列国家质量指标项目经验显示,入院后48小时内进行髋关节骨折修复可降低死亡率

Niv Yaron, Kuniavsky Michael, K. Alexander, Bronshtein Olga, Goldschmidt Nethanel, Han ShuLi, Mahalla Hannah
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引用次数: 0

摘要

背景:髋部骨折在老年人中很常见,原因是缺乏活动能力、骨质减少和低钙血症。48小时内修复股骨颈骨折的手术可改善临床效果。目的:测量髋关节骨折修复术在入院48小时内的执行率,以及对死亡率的影响。方法:数据来源于以色列国家质量指标计划。分母包括所有65岁或65岁以上因髋部骨折入院并接受手术的患者,分子包括入院后48小时内接受手术修复的患者。结果:在48小时内,国家合规水平从2013年的71%显著提高到2018年的87%。2013年、2014年、2015年、2016年、2017年和2018年,全髋关节置换术(THR)的成功率分别为53%、68%、74%、81%、79%和78%,部分髋关节置换术的成功率为66%、76%、80%、82%、84%和86%,固定术的成功度分别为74%、80%、85%、89%、89%和89%。入院后48小时内接受髋关节骨折修复的患者在入院后30天内的死亡率分别为4%和6.1%,比值比(OR)为0.645,95%CI为0.5730.726,P<0.0001。结论:我们可以证明,在入院48小时内接受髋部骨折修复的髋部骨折患者的死亡率显著降低。
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Performing Hip Fracture Repair within 48 Hours from Admission May Decrease Mortality, the Israeli National Program for Quality Indicators Experience
Background: Hip fractures are common among the elderly, due to lack of mobility, osteopenia and hypocalcaemia. Surgery for repairing a fracture in the femoral neck within 48 hours improves the clinical outcome. Objective: To measure the performance rate of hip fracture repair within 48 hours of admission, and the effect on mortality. Methods: The data were obtained from the Israeli National Program for Quality Indicators. The denominator included all the patients 65-year-old or older who was admitted and operated because of hip fracture, and the numerator included those who underwent surgical repair within 48 hours of admission. Results: There has been a significant improvement in the national level of compliance within 48 hour time spanfrom 71% in 2013 to 87% in 2018. The success rate for total hip replacement (THR) was 53%, 68%, 74%, 81%, 79% and 78%, for partial hip replacement (PHR) the success rate was 66%, 76%, 80%, 82%, 84%, and 86%, and for fixation it was 74%, 80%, 85%, 89%, 89% and 89%, for 2013, 2014, 2015, 2016, 2017 and 2018, respectively. The mortality rate within 30 days of the admission was 4% in patients who underwent hip fracture repair within 48 hours of the admission, and 6.1% in the patients who did not, respectively, with odds ratio (OR) of 0.645, 95% CI 0.5730.726, P < 0.0001. Conclusion: We could demonstrate a significant decrease in mortality of patients with hip fracture who underwent hip fracture repair within 48 hours of admission.
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