PDF(Pubmed)
Abstract：
Introduction Surgery is recommended within 24-48 hours for geriatric hip fractures. In developing countries. However, delayed presentation to the hospital due to various factors often precludes surgery from occurring within these recommended intervals. Therefore, our objective was to identify the hurdles that prevent early surgery for geriatric hip fractures and assess their effect on mortality. Methods A prospective cohort study was conducted with 78 geriatric patients (age > 60 years) who suffered hip fractures between September 2019 and November 2020. The demographic, American Society of Anesthesiologists (ASA) classification, Charlson Comorbidity Index (CCI), injury to admission, admission to surgery, and injury to surgery time were all recorded for each patient. A follow-up was conducted at one month and six months postoperatively for each patient. Mortality rate at 30 days and causes for delay in presentation to the hospital and delayed surgery were assessed. Multivariate logistic regression was done to assess the risk factors for 30-day mortality. Results The mean age of the patients was 74.2 years, and 64.1% of the patients were female. The mean (SD) injury-to-admission time was 3.45 (5.50) days, and the admission-to-surgery time was 4.28 (3.03) days. A total of 41% of patients had delayed presentation, commonly due to a lack of local healthcare infrastructure, financial constraints, and a lack of care providers. Furthermore, 65.3% of the patients underwent delayed surgery, and 44% faced organizational delays. Thus, the 30-day mortality rate was calculated at 19.2%, while the six-month mortality rate was 25.6%. The injury to admission time (OR 1.22 [1.03-1.44; p = 0.018]) and CCI were found to be risk factors in the 30-day mortality (OR 1.76 [0.93-3.33; p = 0.085]). Conclusions Pre-hospital delays and CCI are risk factors for short-term mortality following hip fractures. This underlines the need to generate awareness, improve the referral chain, and establish protocol-based care in hospitals. Further studies are required to assess the socioeconomic factors involved in the delayed treatment of geriatric hip fractures in developing countries.
摘要：
介绍对于老年髋部骨折，建议在24-48小时内进行手术。在发展中国家。然而,由于各种因素导致的延迟到医院就诊通常会使手术无法在这些建议的间隔时间内进行.因此,我们的目的是确定阻碍老年髋部骨折早期手术的障碍,并评估其对死亡率的影响.方法对2019年9月至2020年11月间发生髋部骨折的78例老年患者（年龄>60岁）进行前瞻性队列研究。人口统计，美国麻醉医师协会（ASA）分类，Charlson合并症指数（CCI），入院时受伤，手术入院,并记录每位患者的手术损伤时间。每位患者在术后1个月和6个月进行随访。评估了30天的死亡率以及延迟到医院就诊和延迟手术的原因。采用多因素logistic回归分析评估30天死亡率的危险因素。结果患者平均年龄74.2岁,64.1%的患者为女性。平均（SD）损伤至入院时间为3.45（5.50）天，入院至手术时间为4.28（3.03）天。共有41%的患者出现延迟就诊，通常是由于缺乏当地的医疗基础设施，财政限制，缺乏护理提供者。此外，65.3%的患者接受了延迟手术,44%的人面临组织延误。因此，30天死亡率计算为19.2%，而六个月死亡率为25.6%。入院时间损伤（OR1.22[1.03-1.44;p=0.018]）和CCI是30天死亡率的危险因素（OR1.76[0.93-3.33;p=0.085]）。结论院前延误和CCI是髋部骨折后短期死亡的危险因素。这强调了需要产生意识，改善转诊链，并在医院建立基于协议的护理。需要进一步的研究来评估发展中国家老年髋部骨折延迟治疗所涉及的社会经济因素。
