The Clinical Application Of The Fast-track Management Of The Department Of Orthopedics And Traumatology Of Traditional Chinese Medicine With Geriatric Hip Fracture

ObjectiveTo sum up and analyze the influence of the Fast-track Management of the department of orthopedics and traumatology of traditional Chinese medicine with geriatric hip fracture on the prognosis of perioperative period,as we]1 as the risk factors of postoperative death.To explore the clinical significance and application value of the Fast-track Management,to provide clinical basis and thinking for the further improvement of the diagnosis and treatment process model of the geriatric hip fracture.MethodsRetrospectively analyze the data of elderly patients with hip fract.ures over 65 years old who were admitted to our Orthopedics Center from January to December 2017.The patients were divided into two groups according to the admission time:Group A(from January 1,2017 to June 30,2017,before the foundation of.Fast-track Management),Group B(July 1,2017 to Decembc r 31,2017,after the foundation of Fast-track Management).General data of patients(age,gender,fracture type,injured limb,body mass index,preoperative ASA grade),perioperative index(waiting time for surgery,length of surgery time,intraoperative blood loss,complication rate,VAS score for discharge,1-year mortality after surgery,excellent rate of hip Harris functional score at last follow-up,length of hospital stay),and laboratory test indicators before and after surgery(hemoglobin,total white blood cells,total red blood cells,Plasma D-dimer,serum total albumin,C-reactive protein)were compared and statistically analyzed to assess the curative effects.Summarize all the cases of geriatric hip fracture in 2017 of our hospital,to analyze the risk factor of 1-year mortality by using single factor analysis and logistic regression analysis.Results50 patients were enrolled in group A and 68 in group B.All the patients in group A were followed up to 1 year after discharge with no death during hospitalization,11 of them died within 1 year after operation.One in group B died of acute myocardial infarction after surgery and one patient was lost to follow-up after discharged from hospital.The remaining patients were followed up to 1 year and 13 of them died within 1 year after surgery.There were no significant differences in the age,gender,fracture type,injured limb,body mass index,preoperative ASA grade,length of surgery,intraoperative blood loss,1-year mortality,and excellent Harris score(p>0.05).The waiting time for surgery of group A is 164.84±81.88h,which is more than 96.81±59.44h of group B.The incidence of postoperative complications of group A and B is respectively 44%and 25%.VAS score of group A is(6.56±0.76),higher than(4.90±0.86)of group B.The length of stay of group A and B is respectively(18.16±5.56d)and(12.97±8,76d).The difference between these indicators was statistically significant(p<0.05).The difference of laboratory test indicators between group A and B was not significant.The factors including high preoperative ASA grade(Ⅲ,Ⅳ or above),delay surgery(over 4 days after admission),preoperative comorbidities and postoperative complications,were approved to have significant influence on 1-year mortality after surgery.Delay surgery and postoperative complications were turned out to be the independent risk factors to 1-year mortality by the multivariate logistic regression analysis.ConclusionThe Fast-track Management of the department of orthopedics and traumatology of traditional Chinese medicine with geriatric hip fracture can reduce waiting time for surgery,length of stay in hospital,incidence of postoperative complications and discharge pain scores.Delay surgery over 4 days from admission and postoperative complications were independent risk factors to 1-year mortality of the elderly after hip fracture.We should pay more attention to control these factors and reduce postoperative mortality.The research of Fast-track Management with geriatric hip fracture has improved the prognosis of patients to a certain extent.For the further improvement,learning advanced experience of relevant medical treatment process at home and abroad,giving full paly to the advantages of traditional Chinese medicine orthopedics treatment are still necessary.