Systematic review on effects of comprehensive geriatric assessment among patients with hip fractures

Abstract

Objective To comprehensively review the effect of comprehensive geriatric assessment (CGA) on reducing the incidence of delirium, shortening the length of stay and reducing the morbidity among elderly patients with hip fractures. Methods From June 2017 to February 2018, we retrieved the MEDLINE, EMBASE, PubMed, CENTRAL, PsycINFO, China Biology Medicine, China National Knowledge Infrastructure (CNKI) , Vip Database (VIP) and WanFang data published from establishing database to January 2018. We collected the randomized controlled trials and clinical trials on the application of comprehensive geriatric assessment in elderly patients with hip fractures. Two researchers independently explored literature, screen literature and assess the quality of the included literature according to the inclusion and exclusion criteria, and extract the data. ReManv 5.3 was used to Meta-analysis. Results A total of 14 literature were enrolled and RCT. Meta-analysis showed that there was statistical differences in the incidence of delirium [Z=3.33, P=0.001, OR=0.82, 95%CI (0.74-0.92) ]and the morbidity within half a year [Z=2.89, P=0.004, OR=0.66, 95%CI (0.49-0.87) ], function losing rate [Z=2.92, P=0.003, OR=0.82, 95%CI (0.66-0.92) ]but no statistical difference in the length of stay (Z=1.32, P=0.19) between the CGA group and control group. Conclusions CGA can reduce the incidence of delirium among elderly patients with hip fractures after surgery. Compared with the CGA based on elderly ward, CGA based on agile team follow-up has good effects which can reduce the morbidity within half a year and function losing rate of patients. Key words: Aged; Meta-analysis; Comprehensive geriatric assessment; Hip fractures; Delirium; Length of stay; Mortality; Systematic review