Abstract
We aimed to assess the impact of timing of surgery in elderly patients with acute hip fracture on morbidity and mortality. We systematically searched MEDLINE, the Cochrane Library, Embase, PubMed, and trial registries from 01/1997 to 05/2017, as well as reference lists of relevant reviews, archives of orthopaedic conferences, and contacted experts. Eligible studies had to be randomised controlled trials (RCTs) or prospective cohort studies, including patients 60 years or older with acute hip fracture. Two authors independently assessed study eligibility, abstracted data, and critically appraised study quality. We conducted meta-analyses using the generic inverse variance model. We included 28 prospective observational studies reporting data of 31,242 patients. Patients operated on within 48 hours had a 20% lower risk of dying within 12 months (risk ratio (RR) 0.80, 95% confidence interval (CI) 0.66–0.97). No statistical significant different mortality risk was observed when comparing patients operated on within or after 24 hours (RR 0.82, 95% CI 0.67–1.01). Adjusted data demonstrated fewer complications (8% vs. 17%) in patients who had early surgery, and increasing risk for pressure ulcers with increased time of delay in another study. Early hip surgery within 48 hours was associated with lower mortality risk and fewer perioperative complications.
Highlights
Hip fractures in elderly populations are a major public health concern in Europe and the United States (US)[1,2,3]
Our systematic review aimed to answer the following questions: (1) In patients aged 60 years or older with an acute hip fracture, what is the impact of timing of surgery on beneficial and harmful outcomes such as mortality, functional capacity, quality of life, and perioperative complications?
A meta-analysis of three trials29,62,65(2,853 patients) rendered an 18% lower risk of long-term mortality in patients operated on within 24 hours
Summary
Hip fractures in elderly populations are a major public health concern in Europe and the United States (US)[1,2,3]. In Europe, the annual hip fracture incidence for elderly women aged 60 years or older ranges between 0.5% to 1.6% per year[5,6,7]. Factors that influence prognosis of elderly patients after hip fracture are age, gender, comorbidities, anticoagulation therapy, and general physical health status at the time of injury[24]. To provide a comprehensive overview, it is necessary to systematically review the currently available evidence on the impact of timing of surgery in elderly patients with acute hip fracture. (1) In patients aged 60 years or older with an acute hip fracture, what is the impact of timing of surgery on beneficial and harmful outcomes such as mortality, functional capacity, quality of life, and perioperative complications?
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