PDF(Pubmed)
Abstract：
BACKGROUND: Hip hemiarthroplasty has traditionally been used to treat displaced femoral neck fractures in older, frailer patients whilst total hip replacements (THR) have been reserved for younger and fitter patients. However, not all elderly patients are frail, and some may be able to tolerate and benefit from an acute THR. Nonagenarians are a particularly heterogenous subpopulation of the elderly, with varying degrees of independence. Since THRs are performed electively as a routine treatment for osteoarthritis in the elderly, its safety is well established in the older patient. The aim of this study was to compare the safety of emergency THR to elective THR in nonagenarians.
METHODS: A retrospective 10-year cohort study was conducted using data submitted to the National Hip Fracture Database (NHFD) across three hospitals in one large NHS Trust. Data was collected from 126 nonagenarians who underwent THRs between 1st January 2010 - 31st December 2020 and was categorised into emergency THR and elective THR groups. Mortality rates were compared between the two groups. Secondary outcomes were also compared including postoperative complications (dislocations, revision surgeries, and periprosthetic fracture), length of stay in hospital, and discharge destination.
RESULTS: There was no significant difference in mortality between the two groups, with 1-year mortality rates of 11.4% and 12.1% reported for emergency and elective patients respectively (p = 0.848). There were no significant differences in postoperative complication rate and discharge destination. Patients who had emergency THR spent 5.56 days longer in hospital compared to elective patients (p = 0.015).
CONCLUSIONS: There is no increased risk of 1-year mortality in emergency THR compared to elective THR, in a nonagenarian population. Therefore, nonagenarians presenting with a hip fracture who would have been considered for a THR if presenting on an elective basis should not be precluded from an emergency THR on safety grounds.
BACKGROUND: Not necessary as this was deemed not to be clinical research, and was considered to be a service evaluation.
METHODS: A retrospective 10-year cohort study was conducted using data submitted to the National Hip Fracture Database (NHFD) across three hospitals in one large NHS Trust. Data was collected from 126 nonagenarians who underwent THRs between 1st January 2010 - 31st December 2020 and was categorised into emergency THR and elective THR groups. Mortality rates were compared between the two groups. Secondary outcomes were also compared including postoperative complications (dislocations, revision surgeries, and periprosthetic fracture), length of stay in hospital, and discharge destination.
RESULTS: There was no significant difference in mortality between the two groups, with 1-year mortality rates of 11.4% and 12.1% reported for emergency and elective patients respectively (p = 0.848). There were no significant differences in postoperative complication rate and discharge destination. Patients who had emergency THR spent 5.56 days longer in hospital compared to elective patients (p = 0.015).
CONCLUSIONS: There is no increased risk of 1-year mortality in emergency THR compared to elective THR, in a nonagenarian population. Therefore, nonagenarians presenting with a hip fracture who would have been considered for a THR if presenting on an elective basis should not be precluded from an emergency THR on safety grounds.
BACKGROUND: Not necessary as this was deemed not to be clinical research, and was considered to be a service evaluation.
摘要：
背景：髋关节置换术传统上用于治疗老年人移位的股骨颈骨折，脆弱的患者，而全髋关节置换术（THR）已保留给年轻和健康的患者。然而,不是所有的老年患者都很虚弱，有些人可能能够耐受急性THR并从中受益。Nonagenarians是老年人的一个特别异质的亚群，具有不同程度的独立性。由于THR被选择性地作为老年人骨关节炎的常规治疗方法进行，它的安全性在老年患者中已经确立。这项研究的目的是比较紧急THR与非成年患者的选择性THR的安全性。
方法：一项为期10年的回顾性队列研究，使用提交给国家髋部骨折数据库（NHFD）的数据，在一家大型NHS信托基金的三家医院进行。数据来自2010年1月1日至2020年12月31日期间接受THR的126名非年龄患者，并分为紧急THR和选择性THR组。比较两组的死亡率。还比较了次要结果，包括术后并发症（脱位，修正手术,和假体周围骨折)，住院时间,和排放目的地。
结果：两组之间的死亡率没有显着差异，急诊和择期患者的1年死亡率分别为11.4%和12.1%(p=0.848).术后并发症发生率及出院目的地差异无统计学意义。与择期患者相比，急诊THR患者住院时间长5.56天（p=0.015）。
结论：与选择性THR相比，急诊THR的1年死亡率没有增加，在非成年人口中。因此,不应出于安全原因排除因髋部骨折而被考虑进行THR的非年龄患者。
背景：没有必要，因为这被认为不是临床研究，并被认为是服务评估。
方法：一项为期10年的回顾性队列研究，使用提交给国家髋部骨折数据库（NHFD）的数据，在一家大型NHS信托基金的三家医院进行。数据来自2010年1月1日至2020年12月31日期间接受THR的126名非年龄患者，并分为紧急THR和选择性THR组。比较两组的死亡率。还比较了次要结果，包括术后并发症（脱位，修正手术,和假体周围骨折)，住院时间,和排放目的地。
结果：两组之间的死亡率没有显着差异，急诊和择期患者的1年死亡率分别为11.4%和12.1%(p=0.848).术后并发症发生率及出院目的地差异无统计学意义。与择期患者相比，急诊THR患者住院时间长5.56天（p=0.015）。
结论：与选择性THR相比，急诊THR的1年死亡率没有增加，在非成年人口中。因此,不应出于安全原因排除因髋部骨折而被考虑进行THR的非年龄患者。
背景：没有必要，因为这被认为不是临床研究，并被认为是服务评估。
