Best Practices for Elderly Hip Fracture Patients. A Systematic Overview of the Evidence

Abstract

OBJECTIVES:To determine evidence-based best practices for elderly hip fracture patients from the time of hospital admission to 6 months postfracture.DATA SOURCES: MEDLINE, Cochrane Library, CINAHL, Embase, PE-Dro, Ageline, NARIC, and CIRRIE databases were searched for potentially eligible articles published between 1985 and 2004.REVIEW METHODS: Two independent reviewers determined studies appropriate for inclusion using standardized selection criteria, extracted data, evaluated internal validity, and then rated studies according to levels of evidence. Only Level 1 or 2 evidence was included in our summary of clinical recommendations. RESULTS:Spinal anesthesia, pressure-relieving mattresses, perioperative antibiotics, and deep vein thromboses prophylaxes had consistent evidence of benefit. Routine preoperative traction was not associated with any benefits and should be abandoned. Types of surgical management, postoperative wound drainage, and even ''multidisciplinary'' care, lacked sufficient evidence to determine either benefit or harm. There was little evidence to either determine best subacute rehabilitation practices or to direct ongoing medical issues (e.g., nutrition). Studies conducted during the subacute recovery period were heterogeneous in terms of treatment settings, interventions, and outcomes studied and had no clear evidence for best treatment practices. CONCLUSIONS:The evidence for perioperative practices is relatively robust and evidence-based perioperative treatment guidelines can be easily established. Conversely, more evidence is required to better guide the care of elderly patients with hip fracture during the subacute recovery period and convalescence.

Surgical Time of Day Does Not Affect Outcome Following Hip Fracture Fixation

“…Delayed time to surgical fixation for hip fractures increases morbidity and mortality and decreases future function. 15,12 -27,46 Our study confirmed this. Increasing time to surgery led to an increasing number of complications ( P = .0492) and a trend toward higher mortality ( P = .091).…”

Surgical Time of Day Does Not Affect Outcome Following Hip Fracture Fixation

“…Delayed time to surgical fixation for hip fractures increases morbidity and mortality and decreases future function. 15,12 -27,46 Our study confirmed this. Increasing time to surgery led to an increasing number of complications ( P = .0492) and a trend toward higher mortality ( P = .091).…”

Fratura de quadril em idosos: tempo de abordagem cirúrgica e sua associação quanto a delirium e infecção

“…In this research, groups A and B did not differ for postoperative delirium (Table 1), due to the small amount of assessed patients. We found infection (pneumonia, urinary tract infection, and surgical site infection) in 28.5% of the patients, which is consistent to literature reports (5,11,(14)(15)(16) . Among the patients presenting infection, five (83%) were submitted to surgery after 48 hours of admission, and one (17%) was operated within the first 48 hours of hospitalization, but no significant difference was found between groups A and B (Table 2).…”

Cervical Hip Fracture in Afinnish Population: Incidence and Mortality

“…Previous research has shown conflicting results regarding delay to operation (24). Asystematic review of the best practices for elderly hip fracturep atients stated that the time to surgical fixation has been examined in several studies, some reporting adverse effects of surgical delay while others reported minimal negative consequences (25). In our study,delay to surgery did not influence mortality during any follow-up period.…”

Surgical Time of Day Does Not Affect Outcome Following Hip Fracture Fixation

“…Delayed time to surgical fixation for hip fractures increases morbidity and mortality and decreases future function. 15,12 -27,46 Our study confirmed this. Increasing time to surgery led to an increasing number of complications ( P = .0492) and a trend toward higher mortality ( P = .091).…”

Fratura de quadril em idosos: tempo de abordagem cirúrgica e sua associação quanto a delirium e infecção

“…In this research, groups A and B did not differ for postoperative delirium (Table 1), due to the small amount of assessed patients. We found infection (pneumonia, urinary tract infection, and surgical site infection) in 28.5% of the patients, which is consistent to literature reports (5,11,(14)(15)(16) . Among the patients presenting infection, five (83%) were submitted to surgery after 48 hours of admission, and one (17%) was operated within the first 48 hours of hospitalization, but no significant difference was found between groups A and B (Table 2).…”

Cervical Hip Fracture in Afinnish Population: Incidence and Mortality

“…Previous research has shown conflicting results regarding delay to operation (24). Asystematic review of the best practices for elderly hip fracturep atients stated that the time to surgical fixation has been examined in several studies, some reporting adverse effects of surgical delay while others reported minimal negative consequences (25). In our study,delay to surgery did not influence mortality during any follow-up period.…”

Surgical Time of Day Does Not Affect Outcome Following Hip Fracture Fixation

“…Delayed time to surgical fixation for hip fractures increases morbidity and mortality and decreases future function. 15,12 -27,46 Our study confirmed this. Increasing time to surgery led to an increasing number of complications ( P = .0492) and a trend toward higher mortality ( P = .091).…”

Fratura de quadril em idosos: tempo de abordagem cirúrgica e sua associação quanto a delirium e infecção

“…In this research, groups A and B did not differ for postoperative delirium (Table 1), due to the small amount of assessed patients. We found infection (pneumonia, urinary tract infection, and surgical site infection) in 28.5% of the patients, which is consistent to literature reports (5,11,(14)(15)(16) . Among the patients presenting infection, five (83%) were submitted to surgery after 48 hours of admission, and one (17%) was operated within the first 48 hours of hospitalization, but no significant difference was found between groups A and B (Table 2).…”

Cervical Hip Fracture in Afinnish Population: Incidence and Mortality

“…Previous research has shown conflicting results regarding delay to operation (24). Asystematic review of the best practices for elderly hip fracturep atients stated that the time to surgical fixation has been examined in several studies, some reporting adverse effects of surgical delay while others reported minimal negative consequences (25). In our study,delay to surgery did not influence mortality during any follow-up period.…”