Abstract：
BACKGROUND: The efficacy of early surgery in preventing complications among Japanese elderly patients with hip fractures requires further investigation. This study aims to use a comprehensive Japanese hip fracture case database to determine whether surgery within the day of admission and the following day reduces the incidence of complications and mortality during hospitalization in elderly hip fracture patients.
METHODS: We retrospectively analyzed the Japanese National Administrative DPC (Diagnosis Procedure Combination) database from April 2016 to March 2022. Approximately 1100 DPC-affiliated hospitals consistently provided medical records with consent for research. The study investigated the association between postoperative pneumonia, deep vein thrombosis, pulmonary embolism, and mortality during hospitalization after propensity score matching, focusing on surgeries conducted on the day of admission and the following day.
RESULTS: After one-to-one propensity score matching for age, gender, and comorbidity, we identified 146,441 pairs of patients who underwent surgery either within the day of admission and the following day or after the third day of admission. Surgery on the third day or later was independently associated with increased risks of pneumonia, deep vein thrombosis, pulmonary embolism, and mortality during hospitalization with risk ratios of 1.367 (95% CI 1.307-1.426), 1.328 (95% CI 1.169-1.508), 1.338 (95% CI 1.289-1.388), and 1.167 (95% CI 1.103-1.234), respectively.
CONCLUSIONS: A comprehensive study of elderly Japanese patients with hip fractures in the DPC database showed that surgery on admission and the following day is crucial for preventing complications like pneumonia, deep vein thrombosis, pulmonary embolism, and mortality during hospitalization.
METHODS: We retrospectively analyzed the Japanese National Administrative DPC (Diagnosis Procedure Combination) database from April 2016 to March 2022. Approximately 1100 DPC-affiliated hospitals consistently provided medical records with consent for research. The study investigated the association between postoperative pneumonia, deep vein thrombosis, pulmonary embolism, and mortality during hospitalization after propensity score matching, focusing on surgeries conducted on the day of admission and the following day.
RESULTS: After one-to-one propensity score matching for age, gender, and comorbidity, we identified 146,441 pairs of patients who underwent surgery either within the day of admission and the following day or after the third day of admission. Surgery on the third day or later was independently associated with increased risks of pneumonia, deep vein thrombosis, pulmonary embolism, and mortality during hospitalization with risk ratios of 1.367 (95% CI 1.307-1.426), 1.328 (95% CI 1.169-1.508), 1.338 (95% CI 1.289-1.388), and 1.167 (95% CI 1.103-1.234), respectively.
CONCLUSIONS: A comprehensive study of elderly Japanese patients with hip fractures in the DPC database showed that surgery on admission and the following day is crucial for preventing complications like pneumonia, deep vein thrombosis, pulmonary embolism, and mortality during hospitalization.
摘要：
背景：在日本老年髋部骨折患者中，早期手术预防并发症的效果需要进一步研究。本研究旨在使用一个全面的日本髋部骨折病例数据库来确定入院当天和第二天的手术是否降低了老年髋部骨折患者住院期间并发症的发生率和死亡率。
方法：我们回顾性分析了2016年4月至2022年3月的日本国家行政DPC（诊断程序组合）数据库。大约1100个DPC附属医院在同意研究的情况下始终提供医疗记录。这项研究调查了术后肺炎，深静脉血栓形成,肺栓塞,倾向评分匹配后住院期间的死亡率，专注于入院当天和第二天进行的手术。
结果：经过一对一的年龄倾向评分匹配后，性别,和合并症，我们确定了146,441对在入院当天内,次日或入院第三天后接受手术的患者.第三天或之后的手术与肺炎风险增加独立相关。深静脉血栓形成,肺栓塞,住院期间的死亡率为1.367（95%CI1.307-1.426），1.328（95%CI1.169-1.508），1.338（95%CI1.289-1.388），和1.167（95%CI1.103-1.234），分别。
结论：对DPC数据库中的日本老年髋部骨折患者进行的一项综合研究表明，入院时和第二天的手术对于预防肺炎等并发症至关重要，深静脉血栓形成,肺栓塞,住院期间的死亡率。
方法：我们回顾性分析了2016年4月至2022年3月的日本国家行政DPC（诊断程序组合）数据库。大约1100个DPC附属医院在同意研究的情况下始终提供医疗记录。这项研究调查了术后肺炎，深静脉血栓形成,肺栓塞,倾向评分匹配后住院期间的死亡率，专注于入院当天和第二天进行的手术。
结果：经过一对一的年龄倾向评分匹配后，性别,和合并症，我们确定了146,441对在入院当天内,次日或入院第三天后接受手术的患者.第三天或之后的手术与肺炎风险增加独立相关。深静脉血栓形成,肺栓塞,住院期间的死亡率为1.367（95%CI1.307-1.426），1.328（95%CI1.169-1.508），1.338（95%CI1.289-1.388），和1.167（95%CI1.103-1.234），分别。
结论：对DPC数据库中的日本老年髋部骨折患者进行的一项综合研究表明，入院时和第二天的手术对于预防肺炎等并发症至关重要，深静脉血栓形成,肺栓塞,住院期间的死亡率。
