An umbrella review of clinical practice guidelines for the management of patients with hip fractures and a synthesis of recommendations for the pre-operative period.

Abstract

The aim of this review was to locate, retrieve and critically appraise practice guidelines for the management of hip fractures. Given increasing evidence that the early recognition and management of these fractures is integral to achieving optimal outcomes, recommendations for the pre-operative period were synthesized and compared. Hip fractures are associated with high rates of adverse outcomes and high healthcare costs which has resulted in the development of multiple practice guidelines to inform clinical decision-making. An umbrella review of practice guidelines was conducted which included a critical appraisal using the Appraisal of Guidelines, Research and Evaluation-II instrument and a synthesis of pre-operative management recommendations. Multi-phased search for practice guidelines published in English using three bibliographic databases; three guideline network websites and three healthcare safety and quality organization websites with no date limit applied. Search was supplemented by contacting front-line knowledge users and content experts. Steps for evidence-informed practice were followed: form question then search for, appraise and synthesize the evidence. Five practice guidelines were appraised revealing significant variability in quality. The largest variability was in "rigour of development". Recommendations for pre-operative management were grouped into six categories: timing of surgery, expedited patient management, identification and treatment of correctable co-morbidities, pain management, preventative measures and multidisciplinary management. Results of this review illustrate that not all practice guidelines are of equal quality. Given the costs associated with the development and maintenance of high-quality practice guidelines, such work may be more efficiently completed through international collaborations and then adapted for national and regional healthcare contexts.