周末入院对老年髋部骨折疗效的影响

Effect of weekend admission on geriatric hip fractures

目的:研究周末入院对老年髋部骨折患者疗效的影响。方法:采用回顾性研究方法,连续纳入2018年11月至2019年11月收治的老年(年龄≥65岁)髋部骨折患者1009例,根据患者入院时间分为工作日入院组(周一至周四入院)388例和周末入院组(周五至周日入院)621例。收集患者基线资料和治疗相关资料,并于入院后30 d、120 d、1年进行随访,随访患者生存情况和并发症情况。结果:周末入院组与工作日入院组患者基线资料差异均无统计学意义(P>0.05)。与工作日入院组患者相比,周末入院组患者入院48 h内手术率显著降低(64.2%vs.81.6%,P<0.001),术前等待时间和住院时间均显著增加(P<0.05),30 d内并发症发生率显著增加(11.9%vs.7.7%,P=0.028)。两组患者院内、30 d、120 d和1年死亡率及1年内再次手术率差异均无统计学意义(P>0.05)。结论:周末入院会延长老年髋部骨折患者术前等待时间,增加并发症发生率,应制定相应的流程和路径以降低周末入院对老年髋部骨折患者疗效的影响。

Objective:To evaluate the effect of weekend admission on the care of elderly patients with hip fracture.Methods:A retrospective study was performed on consecutively managed acute hip fracture patients aged 65 or more from November 2018 to November 2019.Patients were divided into two groups according to the time admitted to the ward:weekday group(admission from Monday to Thursday,388 cases)and weekend group(admission from Friday to Sunday,621 cases).The baseline data and treatment related data were recorded.Follow-up was performed at 30 d,120 d and 1 year after admission.Results:There was no significant difference in baseline data between the two groups(P>0.05).Proportion of patients receiving surgery within 48 hours from ward arrival was significantly lower in the weekend group compared with the weekday group(64.2%vs.81.6%,P<0.001).The time between admission and operation,and the length of hospital stay were significantly increased in the weekend group(P<0.05).The incidence of complication within 30 days of admission was significantly higher than in the weekend group(11.9%vs.7.7%,P=0.028).There was no significant difference in in-hospital,30-day,120-day,and 1-year mortality rate and 1-year re-operation rate between the two groups(P>0.05).Conclusions:Weekend admission can prolong the waiting time to surgery and increase the early complications in older hip fracture patients.Clinical pathway is needed to decrease the weekend effect on geriatric hip fractures.