학술논문
Can the prognostic score proposed by Elliot serve as an educational tool to shorten the time to surgery for hip fractures in geriatric patients?
Document Type
Academic Journal
Author
Alain A; Service d'orthopédie-traumatologie, CHU de Dupuytren, 2, avenue Martin Luther King, 87042 Limoges cedex, France.; Cunique T; Service d'orthopédie-traumatologie, CHU de Dupuytren, 2, avenue Martin Luther King, 87042 Limoges cedex, France.; Abane C; Service d'orthopédie-traumatologie, CHU de Dupuytren, 2, avenue Martin Luther King, 87042 Limoges cedex, France.; Hardy J; Service d'orthopédie-traumatologie, CHU de Dupuytren, 2, avenue Martin Luther King, 87042 Limoges cedex, France.; Mabit C; Service d'orthopédie-traumatologie, CHU de Dupuytren, 2, avenue Martin Luther King, 87042 Limoges cedex, France.; Marcheix PS; Service d'orthopédie-traumatologie, CHU de Dupuytren, 2, avenue Martin Luther King, 87042 Limoges cedex, France. Electronic address: psmarcheix@orange.fr.
Source
Publisher: Elsevier Masson SAS Country of Publication: France NLM ID: 101494830 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1877-0568 (Electronic) Linking ISSN: 18770568 NLM ISO Abbreviation: Orthop Traumatol Surg Res Subsets: MEDLINE
Subject
Language
English
Abstract
Introduction: Hip fractures require surgical treatment within 48hours to decrease the risk of postoperative complications. Elliott proposed a prognostic score to identify which patients should be prioritized for surgery. This study was designed to answer the following questions: 1- Does using this score shorten the time to surgery? 2- Does shortening the time to surgery reduce mortality at 6 months and 1 year? 3- What factors delay the surgical procedure? We hypothesized that using this score as an educational tool would reduce the time to surgery in patients over 75 years of age who have a hip fracture.
Material and Methods: This single-center study involved two populations: 244 patients were included prospectively who had the score applied with the aim of optimizing the time to surgery; 476 patients were included from a historical cohort to serve as a reference group.
Results: The mean time to surgery was 2.5 days±1.9 [95% CI: 2.41-2.77] and the median was 2 days (minimum 0, maximum 18 days) in the reference group; the mean was 1.4 days±1.0 [95% CI: 1.46-1.67] and the median was 1 day (min. 0, max 6 days) in the prospective cohort, which was a significant reduction (p<0.001). At 6 months, the mortality rate was 22.5% in the reference population and 23% in the prospective cohort. At 1 year, the mortality rate was 47% and 46%, respectively, with no significant difference. Surgical delays were attributed to lack of OR availability, management of anticoagulants, request for cardiac ultrasound and administrative reasons.
Discussion/conclusion: Elliot's prognostic at-risk score for hip fracture can shorten the time to surgery when used an educational tool to raise the medical staff's awareness of the benefits of rapid surgical care.
Level of Evidence: IV; retrospective study without control group.
(Copyright © 2023 Elsevier Masson SAS. All rights reserved.)
Material and Methods: This single-center study involved two populations: 244 patients were included prospectively who had the score applied with the aim of optimizing the time to surgery; 476 patients were included from a historical cohort to serve as a reference group.
Results: The mean time to surgery was 2.5 days±1.9 [95% CI: 2.41-2.77] and the median was 2 days (minimum 0, maximum 18 days) in the reference group; the mean was 1.4 days±1.0 [95% CI: 1.46-1.67] and the median was 1 day (min. 0, max 6 days) in the prospective cohort, which was a significant reduction (p<0.001). At 6 months, the mortality rate was 22.5% in the reference population and 23% in the prospective cohort. At 1 year, the mortality rate was 47% and 46%, respectively, with no significant difference. Surgical delays were attributed to lack of OR availability, management of anticoagulants, request for cardiac ultrasound and administrative reasons.
Discussion/conclusion: Elliot's prognostic at-risk score for hip fracture can shorten the time to surgery when used an educational tool to raise the medical staff's awareness of the benefits of rapid surgical care.
Level of Evidence: IV; retrospective study without control group.
(Copyright © 2023 Elsevier Masson SAS. All rights reserved.)