老年新鲜骨折患者加速康复外科理念实施的依从性分析

Compliance with enhanced recovery after surgery protocol in geriatric patients with fresh fracture

目的分析加速康复外科(ERAS)理念下老年新鲜骨折患者对围手术期处理措施实施的依从性。方法回顾性分析2019年5月至2022年1月进入到北京积水潭医院创伤骨科ERAS围手术期处理流程数据库的四肢新鲜骨折患者资料。筛选年龄≥65岁的患者为观察组,然后按照性别、骨折类型和住院时间时段通过1∶1匹配年龄<65岁的患者得到对照组。比较两组患者对14条ERAS核心围手术期处理措施实施的依从性。结果观察组和对照组各66例患者纳入研究,两组患者性别、骨折类型完全匹配。观察组中62.1%(41/66)的患者合并其他疾病,显著高于对照组的16.7%(11/66),差异有统计学意义(P<0.001)。两组患者对14条ERAS核心围手术期处理措施的依从率均为78.6(71.4,85.7)%,差异无统计学意义(P>0.05)。除术后尽早恢复经口饮食观察组患者依从率(80.3%,53/66)较对照组(92.4%,61/66)低外,差异有统计学意义(P<0.05),其他13条处理措施两组间依从率比较差异均无统计学意义(P>0.05)。结论ERAS围手术期处理措施在老年新鲜骨折患者中实施良好,可以获得与非老年患者差不多的依从率。

Objective To analyze the compliance with enhanced recovery after surgery(ERAS)protocol in geriatric patients with fresh fracture.Methods A retrospective study was conducted on the data of the patients with fresh extremity fracture which had been included in the ERAS perioperative protocol database during May 2019 and January 2022 at Department of Orthopaedic Trauma,Beijing Jishuitan Hospital.The patients≥65 years were selected as a study group which was matched by a control group of the patients<65 years in sex,fracture type and date frame of hospitalization at a ratio of 1∶1.The 2 groups were compared in the compliance with the 14 ERAS core perioperative elements.Results The study group and the control group each included 66 patients who were matched in sex and fracture type.62.1%(41/66)of the patients in the study group had combined diseases,significantly more than that[16.7%(11/66)]in the control group(P<0.001).Altogether,the compliance with the 14 ERAS core perioperative elements was 78.6(71.4,85.7)%in both groups,showing no significant difference between them(P>0.05).Respectively,the compliance with the postoperative oral intake in the study group(80.3%,53/66)was significantly lower than that in the control group(92.4%,61/66)(P<0.05);the compliance with the other 13 elements showed no statistically significant difference between the 2 groups(P>0.05).Conclusion The ERAS perioperative protocol can be carried out smoothly in geriatric patients with fresh fracture whose compliance may be comparable to that of the none-elderly patients.