PDF(Pubmed)
Abstract：
BACKGROUND: \"Multidisciplinary fast-track\" (MFT) care can accelerate recovery and improve prognosis after surgery, but whether it is effective in older people after hip fracture surgery is unclear.
METHODS: We retrospectively compared one-year all-cause mortality between hip fracture patients at least 80 years old at our institution who underwent hip fracture surgery between January 2014 and December 2018 and who then received MFT or conventional care. Multivariable regression was used to assess the association between MFT care and mortality after adjustment for confounders.
RESULTS: The final analysis included 247 patients who received MFT care and 438 who received conventional orthopedic care. The MFT group showed significantly lower one-year mortality (8.9% vs. 14.4%, P = 0.037). Log-rank testing of Kaplan-Meier survival curves confirmed the survival advantage. However, the two groups did not differ significantly in rates of mortality during hospitalization or at 30 or 90 days after surgery. Regression analysis confirmed that MFT care was associated with lower risk of one-year mortality (hazard ratio [HR] 0.47, 95% confidence interval [CI] 0.281-0.788, P = 0.04), and the survival benefit was confirmed in subgroups of patients with anemia (HR 0.453, 95% CI 0.268-0.767, P = 0.003) and patients with American Society of Anesthesiologists grade III (HR 0.202, 95% CI 0.08-0.51, P = 0.001).
CONCLUSIONS: MFT care can reduce one-year mortality among hip fracture patients at least 80 years old. This finding should be verified and extended in multi-center randomized controlled trials.
METHODS: We retrospectively compared one-year all-cause mortality between hip fracture patients at least 80 years old at our institution who underwent hip fracture surgery between January 2014 and December 2018 and who then received MFT or conventional care. Multivariable regression was used to assess the association between MFT care and mortality after adjustment for confounders.
RESULTS: The final analysis included 247 patients who received MFT care and 438 who received conventional orthopedic care. The MFT group showed significantly lower one-year mortality (8.9% vs. 14.4%, P = 0.037). Log-rank testing of Kaplan-Meier survival curves confirmed the survival advantage. However, the two groups did not differ significantly in rates of mortality during hospitalization or at 30 or 90 days after surgery. Regression analysis confirmed that MFT care was associated with lower risk of one-year mortality (hazard ratio [HR] 0.47, 95% confidence interval [CI] 0.281-0.788, P = 0.04), and the survival benefit was confirmed in subgroups of patients with anemia (HR 0.453, 95% CI 0.268-0.767, P = 0.003) and patients with American Society of Anesthesiologists grade III (HR 0.202, 95% CI 0.08-0.51, P = 0.001).
CONCLUSIONS: MFT care can reduce one-year mortality among hip fracture patients at least 80 years old. This finding should be verified and extended in multi-center randomized controlled trials.
摘要：
背景：“多学科快速跟踪”（MFT）护理可以加速恢复并改善手术后的预后，但对老年人髋部骨折手术后是否有效尚不清楚。
方法：我们回顾性比较了在2014年1月至2018年12月期间在我们机构接受髋部骨折手术并随后接受MFT或常规护理的80岁以上髋部骨折患者的一年全因死亡率。在校正混杂因素后，使用多变量回归来评估MFT护理与死亡率之间的关联。
结果：最终分析包括接受MFT护理的247例患者和接受常规骨科护理的438例患者。MFT组的一年死亡率显着降低（8.9％vs.14.4%,P=0.037)。Kaplan-Meier存活曲线的对数秩检验证实了生存优势。然而,两组在住院期间或术后30或90天的死亡率方面无显著差异.回归分析证实，MFT护理与较低的一年死亡率风险相关（风险比[HR]0.47，95%置信区间[CI]0.281-0.788，P=0.04）。并且在贫血患者(HR0.453,95%CI0.268-0.767,P=0.003)和美国麻醉医师协会III级患者(HR0.202,95%CI0.08-0.51,P=0.001)的亚组中证实了生存获益。
结论：MFT治疗可降低80岁以上髋部骨折患者1年死亡率。这一发现应该在多中心随机对照试验中得到验证和扩展。
方法：我们回顾性比较了在2014年1月至2018年12月期间在我们机构接受髋部骨折手术并随后接受MFT或常规护理的80岁以上髋部骨折患者的一年全因死亡率。在校正混杂因素后，使用多变量回归来评估MFT护理与死亡率之间的关联。
结果：最终分析包括接受MFT护理的247例患者和接受常规骨科护理的438例患者。MFT组的一年死亡率显着降低（8.9％vs.14.4%,P=0.037)。Kaplan-Meier存活曲线的对数秩检验证实了生存优势。然而,两组在住院期间或术后30或90天的死亡率方面无显著差异.回归分析证实，MFT护理与较低的一年死亡率风险相关（风险比[HR]0.47，95%置信区间[CI]0.281-0.788，P=0.04）。并且在贫血患者(HR0.453,95%CI0.268-0.767,P=0.003)和美国麻醉医师协会III级患者(HR0.202,95%CI0.08-0.51,P=0.001)的亚组中证实了生存获益。
结论：MFT治疗可降低80岁以上髋部骨折患者1年死亡率。这一发现应该在多中心随机对照试验中得到验证和扩展。
