Pre-operative indicators for mortality following hip fracture surgery: a systematic review and meta-analysis

Toby Smith, Kelum Pelpola, Martin Ball, Alice Ong, Phyo Kyaw Myint

Research output: Contribution to journalArticle

141 Citations (Scopus)

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DESIGN: systematic search of published and unpublished literature databases, including EMBASE, MEDLINE, AMED, CINAHL, PubMed and the Cochrane Library, was undertaken to identify all clinical studies on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.

Original languageEnglish
Pages (from-to)464-471
Number of pages8
JournalAge and Ageing
Volume43
Issue number4
Early online date3 Jun 2014
DOIs
Publication statusPublished - Jul 2014

Fingerprint

Hip Fractures
Meta-Analysis
Mortality
PubMed
MEDLINE
Libraries
Comorbidity
Electrocardiography
Databases
Confidence Intervals

Keywords

  • elderly
  • femoral fracture
  • mortality
  • older people
  • prognostic indicators
  • risk factors
  • systematic review

Cite this

Pre-operative indicators for mortality following hip fracture surgery : a systematic review and meta-analysis. / Smith, Toby; Pelpola, Kelum; Ball, Martin; Ong, Alice; Myint, Phyo Kyaw.

In: Age and Ageing, Vol. 43, No. 4, 07.2014, p. 464-471.

Research output: Contribution to journalArticle

Smith, Toby ; Pelpola, Kelum ; Ball, Martin ; Ong, Alice ; Myint, Phyo Kyaw. / Pre-operative indicators for mortality following hip fracture surgery : a systematic review and meta-analysis. In: Age and Ageing. 2014 ; Vol. 43, No. 4. pp. 464-471.
@article{e72ae296a245425eb244235214ee26bd,
title = "Pre-operative indicators for mortality following hip fracture surgery: a systematic review and meta-analysis",
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.",
keywords = "elderly, femoral fracture, mortality, older people, prognostic indicators, risk factors, systematic review",
author = "Toby Smith and Kelum Pelpola and Martin Ball and Alice Ong and Myint, {Phyo Kyaw}",
note = "{\circledC} The Author 2014. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com.",
year = "2014",
month = "7",
doi = "10.1093/ageing/afu065",
language = "English",
volume = "43",
pages = "464--471",
journal = "Age and Ageing",
issn = "0002-0729",
publisher = "OXFORD UNIV PRESS INC",
number = "4",

}

TY - JOUR

T1 - Pre-operative indicators for mortality following hip fracture surgery

T2 - a systematic review and meta-analysis

AU - Smith, Toby

AU - Pelpola, Kelum

AU - Ball, Martin

AU - Ong, Alice

AU - Myint, Phyo Kyaw

N1 - © The Author 2014. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

PY - 2014/7

Y1 - 2014/7

N2 - 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.

AB - 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.

KW - elderly

KW - femoral fracture

KW - mortality

KW - older people

KW - prognostic indicators

KW - risk factors

KW - systematic review

U2 - 10.1093/ageing/afu065

DO - 10.1093/ageing/afu065

M3 - Article

C2 - 24895018

VL - 43

SP - 464

EP - 471

JO - Age and Ageing

JF - Age and Ageing

SN - 0002-0729

IS - 4

ER -