Toby Smith1, Kelum Pelpola2, Martin Ball1, Alice Ong3, Phyo Kyaw Myint4. 1. Faculty of Medicine and Health Sciences, Queen's Building, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK. 2. Care of the Elderly Department, Colchester General Hospital, Turner Road, Colchester, UK. 3. Department of Medicine for the Elderly, Norfolk and Norwich University, Norwich, UK. 4. School of Medicine and Dentistry, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, UK.
Abstract
OBJECTIVE: hip fracture is a common and serious condition associated with high mortality. This study aimed to identify pre-operative characteristics which are associated with an increased risk of mortality after hip fracture surgery. DESIGN: systematic search of published and unpublished literature databases, including EMBASE, MEDLINE, AMED, CINAHL, PubMed and the Cochrane Library, was undertaken to identify all clinical studies on pre-operative predictors of mortality after surgery in hip fracture with at least 3-month follow-up. Data pertaining to the study objectives was extracted by two reviewers independently. Where study homogeneity was evidence, a meta-analysis of pooled relative risk and 95% confidence intervals was performed for mortality against pre-admission characteristics. RESULTS: fifty-three studies including 544,733 participants were included. Thirteen characteristics were identified as possible pre-operative indicators for mortality. Following meta-analysis, the four key characteristics associated with the risk of mortality up to 12 months were abnormal ECG (RR: 2.00; 95% CI: 1.45, 2.76), cognitive impairment (RR: 1.91; 95% CI: 1.35, 2.70), age >85 years (RR: 0.42; 95% CI: 0.20, 0.90) and pre-fracture mobility (RR: 0.13; 95% CI: 0.05, 0.34). Other statistically significant pre-fracture predictors of increased mortality were male gender, being resident in a care institution, intra-capsular fracture type, high ASA grade and high Charlson comorbidity score on admission. CONCLUSIONS: this review has identified the characteristics of patients with a high risk of mortality after a hip fracture surgery beyond the peri-operative period who may benefit from comprehensive assessment and appropriate management. PROSPERO REGISTRATION NUMBER: CRD42012002107.
OBJECTIVE:hip fracture is a common and serious condition associated with high mortality. This study aimed to identify pre-operative characteristics which are associated with an increased risk of mortality after hip fracture surgery. DESIGN: systematic search of published and unpublished literature databases, including EMBASE, MEDLINE, AMED, CINAHL, PubMed and the Cochrane Library, was undertaken to identify all clinical studies on pre-operative predictors of mortality after surgery in hip fracture with at least 3-month follow-up. Data pertaining to the study objectives was extracted by two reviewers independently. Where study homogeneity was evidence, a meta-analysis of pooled relative risk and 95% confidence intervals was performed for mortality against pre-admission characteristics. RESULTS: fifty-three studies including 544,733 participants were included. Thirteen characteristics were identified as possible pre-operative indicators for mortality. Following meta-analysis, the four key characteristics associated with the risk of mortality up to 12 months were abnormal ECG (RR: 2.00; 95% CI: 1.45, 2.76), cognitive impairment (RR: 1.91; 95% CI: 1.35, 2.70), age >85 years (RR: 0.42; 95% CI: 0.20, 0.90) and pre-fracture mobility (RR: 0.13; 95% CI: 0.05, 0.34). Other statistically significant pre-fracture predictors of increased mortality were male gender, being resident in a care institution, intra-capsular fracture type, high ASA grade and high Charlson comorbidity score on admission. CONCLUSIONS: this review has identified the characteristics of patients with a high risk of mortality after a hip fracture surgery beyond the peri-operative period who may benefit from comprehensive assessment and appropriate management. PROSPERO REGISTRATION NUMBER: CRD42012002107.
Authors: L Beaupre; B Sobolev; P Guy; J D Kim; L Kuramoto; K J Sheehan; J M Sutherland; E Harvey; S N Morin Journal: Osteoporos Int Date: 2019-04-01 Impact factor: 4.507
Authors: J J Aarden; M van der Esch; R H H Engelbert; M van der Schaaf; S E de Rooij; B M Buurman Journal: J Nutr Health Aging Date: 2017 Impact factor: 4.075
Authors: Mary Anderson Wallace; Andrew Hammes; Micol S Rothman; Anastasiya A Trizno; Christine D Jones; Ethan Cumbler; Kelly McDevitt; Nichole E Carlson; Jason W Stoneback Journal: Perm J Date: 2019-11-01
Authors: Megan L Salter; Xinran Liu; Sunjae Bae; Nadia M Chu; Alexandra Miller Dunham; Casey Humbyrd; Dorry L Segev; Mara A McAdams-DeMarco Journal: J Am Geriatr Soc Date: 2019-05-06 Impact factor: 5.562
Authors: A Gamboa; E Duaso; P Marimón; M Sandiumenge; E Escalante; C Lumbreras; A Tarrida Journal: Osteoporos Int Date: 2018-08-03 Impact factor: 4.507
Authors: Christine S Ritchie; Amy S Kelley; Irena Stijacic Cenzer; Alexander K Smith; Margaret L Wallhagen; Kenneth E Covinsky Journal: J Pain Symptom Manage Date: 2016-08-09 Impact factor: 3.612
Authors: E C Folbert; J H Hegeman; M Vermeer; E M Regtuijt; D van der Velde; H J Ten Duis; J P Slaets Journal: Osteoporos Int Date: 2016-07-21 Impact factor: 4.507
Authors: G Mazziotti; A M Formenti; M B Panarotto; E Arvat; A Chiti; A Cuocolo; M E Dottorini; C Durante; L Agate; S Filetti; F Felicetti; A Filice; L Pace; T Pellegrino; M Rodari; M Salvatori; C Tranfaglia; A Versari; D Viola; S Frara; A Berruti; A Giustina; R Giubbini Journal: Endocrine Date: 2017-11-06 Impact factor: 3.633