| Background and purpose:With the coming of aging society in China,the proportion and number of elderly hip fracture are increasing year by year.Because of the high disability rate,high mortality rate and serious economic burden,researchers have to find a suitable treatment pathway to improve the curative effect and prognosis of patients.Compared with the previous usual pathway to admit and treat patients,the fast-track based on multidisciplinary cooperation can shorten the time to surgery and play a good role in the diagnosis and treatment of hip fracture in the elderly,thus it has been gradually applied.Hip fracture is usually studied as a whole in the past.However,femoral neck fracture,as one of the common types of hip fracture,has its own clinical characteristics and surgical selection tendency.The purpose of this study is to analyze the curative effect of fast-track applied in the elderly femoral neck fracture and explore the risk factors of death in elderly patients with femoral neck fracture.Methods: The data of 107 elderly patients with femoral neck fracture who underwent surgical treatment in our center in 2021 were reviewed.The patients entering the fast-track are defined as the fast-track group(FT),and the patients admitted through the traditional pathway are defined as the usual pathway group(UP).The general data of patients in the two treatment modes were collected,including intraoperative data,length of stay(LOS),postoperative blood transfusion rate,perioperative albumin transfusion rate,perioperative Intensive Care Unit(ICU)transfer rate,postoperative complications and cost.The data of hip joint function and postoperative death situation were followed up.The data were statistically analyzed by SPSS.The data conforming to the normal distribution were expressed by X±S,and the comparison between groups was made by t-test.The data of non-normal distribution is represented by [M(P25,P75)] and Mann-Whitney U test is used for analysis.Enumeration data were expressed as(rate),and inter-group comparison was performed using Chi-square test or Fisher’s exact probability method.The Kaplan-Meier curve was used to analyze the survival rate of patients,and Graph Pad Prism 9 software was used to draw.The independent risk factors of patients’ death were analyzed by univariate and multivariate Cox regression,and p<0.05 was statistically significant.Results: A total of 107 patients were included in this study,of which 100% were followed up for death and 81.3%(87 cases)for hip function.The median follow-up time of patients was19 months(IQR19-22 months).The median time to surgery and the median LOS in the FT group were shorter than those in the UP group(p=0.000).There were no significant differences in LOS after operative,postoperative complications,perioperative blood transfusion rate,perioperative albumin transfusion rate and ICU transfer rate.The function recovery and daily living ability of patients who survived of patients in FT group were better than those in UP group.The survival rate of the two groups was statistically different(93.6% vs 80.1%;p=0.023)。Multivariate Cox regression analysis showed that Alzheimer’s disease(HR=7.135,95%CI: 1.827-27.869,p=0.005)and cardiac valve insufficiency(HR = 10.657,95%,CI: 1.639-69.315,p=0.013)were related risk factors for the death of elderly patients with femoral neck fracture.Fast track has no significance for the survival rate of two groups of patients.Conclusion:Fast-track surgery can effectively reduce patients’ time to surgery,reduce LOS,save medical costs,enable patients to achieve good functional recovery,and further improve their quality of life,which has significant social benefits.However,it is necessary to pay attention to the cognitive function changes of elderly patients with femoral neck fracture after discharge and closely follow up the heart valve disease,which may help reduce their mortality. |
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