Anaesthesia:如何衡量老年患者髋部骨折术后恢复情况,存活天数or居家天数?

2022-05-18 医路坦克 MedSci原创

活天数和居家天数已经在外科人群中得到验证,并用于评估特定患者因素和外科手术的结果,本文目的是调查手术后90天内存活天数和居家天数作为髋部骨折手术修复患者的研究指标的实用性。

近几十年来,麻醉的质量保证越来越受到重视,不仅包括安全性,还包括患者的体验感受。手术结果传统上是通过死亡率或住院时间评价的。然而,这些终点只能部分反映患者术后的恢复过程和生存质量。

术后存活天数和在家天数的预后评价“有三个因素:最初的急性和亚急性住院;再次入院和/或新的护理机构入院的持续时间;以及死亡率。通过结合这些结果指标,存活天数和居家天数反映了生活质量和日常功能。在老年人中,居家天数可能反映出死亡、长期住院或永久转移到更高水平的护理。因此,存活天数的日子和居家的日子代表着一种务实的、以病人为中心的结果衡量标准,大致相当于在“良好”健康状态下所花费的时间。存活天数和居家天数包括多个术后关键事件和体重。与围手术期研究中许多基于并发症的结果不同,在家中多待几天比少待几天要好。

存活天数和居家天数已经在外科人群中得到验证,并用于评估特定患者因素和外科手术的结果。然而,关于手术后30天内在家中存活的天数与手术后90天内活着的天数的相对价值存在争议;后者收集起来更复杂,可能不会为许多手术人群增加重要的新信息。

髋部骨折手术是老年人最常见的紧急手术之一,目前很少有关于髋部骨折手术后存活天数和居家天数的研究。这是一个高危患者群体,可能会延长住院时间、出现多种并发症、频繁再入院和高死亡率。我们的目的是调查手术后90天内存活天数和居家天数作为髋部骨折手术修复患者的研究指标的实用性。

我们在髋部骨折手术后的老年人中评估了这一指标,并评估了两个随访时间,30天和90天。通过住院和政府死亡记录,对接受髋部骨折手术的70岁以上的≥患者进行回顾性鉴定。成功回家并在手术后90天内仍然活着的患者与那些没有回家的患者被区分开来。回归模型被用来检验哪些变量与手术后90天内回家的人不回家和在家呆的天数有关。我们分析了825名患者的病历。中位数(IQR[范围])90天内(n=788)在家天数为54(0-76[0-88])天,30天内(n=797)为2(0-21[0-28])天。

在这些患者中,274名(35%)患者在手术后90天内没有回家,374名患者(47%)在术后30天内没有回家。已知的围手术期危险因素,如高龄、术前贫血和术后急性肾功能损害与不能回家有关。

这项研究支持活着和在家的日子,作为老年人髋部骨折手术后以患者为中心的有用的结果衡量标准。我们建议在临床试验中使用这一指标,并在术后90天而不是30天进行测量。由于近一半的患者在30天内没有回家,较短的时间段捕捉到的有意义的事件较少。

文献来源:Wu A,  Fahey MT,  Cui D,An evaluation of the outcome metric 'days alive and at home' in older patients after hip fracture surgery.Anaesthesia 2022 Apr 30; 

 

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    2022-08-31 AspirantSuo
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    2022-05-12 liuquan
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    2022-05-12 skhzy

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