多学科诊疗模式对老年髋部骨折患者术后30 d病死率和术后并发症的影响

Impact of multidisciplinary diagnosis and treatment on postoperative 30-day mortality and complications in elderly patients with hip fracture

目的探讨多学科诊疗模式对老年髋部骨折患者术后30 d病死率和术后并发症的影响。方法回顾性分析2018年6月至2019年10月期间深圳市第二人民医院骨科老年髋部骨折病区采用多学科诊疗模式治疗的260例老年髋部骨折患者资料(共管组)。男66例,女194例;年龄为(78.7±5.1)岁;骨折类型:股骨颈骨折141例,股骨转子间骨折114例,股骨转子下骨折5例。并与2017年1月至2018年5月期间采用传统治疗模式治疗的242例老年髋部骨折患者资料(传统组)进行比较。比较两组患者的术前等待时间、48 h内手术率、术后30 d病死率、术后肺炎及压疮发生率等。结果两组患者的术前一般资料及治疗方式比较差异均无统计学意义(P>0.05),具有可比性。共管组患者术前等待时间为(41.9±36.5)h,显著短于传统组患者[(71.4±13.9)h];48 h内手术率为66.5%(173/260),显著高于传统组患者(8.7%,21/242),差异均有统计学意义(P<0.05)。共管组患者术后肺炎发生率(3.1%,8/260)显著低于传统组患者(9.9%,24/242),术后压疮发生率(5.4%,14/260)显著低于传统组患者(11.2%,27/242),术后30 d病死率(2.3%,6/260)显著低于传统组患者(5.8%,14/242),差异均有统计学意义(P<0.05)。结论通过多学科诊疗体系的建立,患者术前等待时间显著缩短,这样不仅可以降低老年髋部骨折患者术后并发症的发生率,而且可以降低术后30 d病死率。

Objective To investigate the impact of multidisciplinary diagnosis and treatment on postoperative 30-day mortality and complications in elderly patients with hip fracture.Methods A retrospective analysis was conducted of the 260 elderly patients with hip fracture who had been treated by the mode of multidisciplinary diagnosis and treatment at Department of Orthopedics,Shenzhen Second People's Hospital from June 2018 to October 2019.The multidisciplinary group consisted of 66 males and 194 females with an age of 78.7 years±5.1 years,and 141 femoral neck fractures,114 intertrochanteric fractures and 5 subtrochanteric fractures.They were compared with the 242 elderly patients with hip fracture(traditional group)who had been treated by the traditional mode from January 2017 to May 2018.The 2 groups were compared in terms of preoperative waiting time,48-hour operation rate,30-day mortality,and incidences of postoperative pneumonia and pressure ulcer.Results There were no statistically significant differences in the preoperative general data or operative procedures between the 2 groups,showing comparability(P>0.05).For the multidisciplinary group,preoperative waiting time was 41.9 h±36.5 h,significantly shorter than that for the traditional group(71.4 h±13.9 h),48-hour operation rate 66.5%(173/260),significantly higher than that for the traditional group(8.7%,21/242),incidence of postoperative pneumonia 3.1%(8/260),significantly lower than that for the traditional group(9.9%,24/242),incidence of postoperative pressure ulcer(5.4%,14/260),significantly lower than that for the traditional group(11.2%,27/242),and 30-day mortality(2.3%,6/260),significantly lower than that for the traditional group(5.8%,14/242)(all P<0.05).Conclusions Establishment of a mode of multidisciplinary diagnosis and treatment can significantly reduce the prolonged preoperative waiting time for elderly patients with hip fracture,thereby greatly reducing postoperative complications and postoperative 30-day mortality.