Clinical outcomes and treatment of hip fractures

Lyons, A. R.

doi:10.1016/s0002-9343(97)90027-9

Cited by 207 publications

(129 citation statements)

References 79 publications

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“…Patients with three or more comorbidities [40] or Category III or IV ASA rating generally possess inferior physical capacity, and consequently, their rehabilitation training is limited. Several studies have shown dementia decreases the likelihood of recovery of prefracture ambulatory status [17,22,27], a finding our study confirms. Because patients with severe dementia have poor motivation and are unable to follow instructions, it is difficult for them to complete the rehabilitation schedule [22,27].…”

Section: Discussionsupporting

confidence: 87%

“…Several studies have shown dementia decreases the likelihood of recovery of prefracture ambulatory status [17,22,27], a finding our study confirms. Because patients with severe dementia have poor motivation and are unable to follow instructions, it is difficult for them to complete the rehabilitation schedule [22,27]. Therefore, patients with three or more comorbidities, Category III or IV ASA rating, or moderate to severe dementia were less likely to regain their prefracture ambulatory status.…”

Section: Discussionsupporting

confidence: 87%

See 1 more Smart Citation

Predictors of Prognosis for Elderly Patients with Poststroke Hemiplegia Experiencing Hip Fractures

Feng

Zhang

Shen

et al. 2009

Clinical Orthopaedics &Amp; Related Research

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Section: Discussionsupporting

confidence: 87%

Section: Discussionsupporting

confidence: 87%

Predictors of Prognosis for Elderly Patients with Poststroke Hemiplegia Experiencing Hip Fractures

Feng

Zhang

Shen

et al. 2009

Clinical Orthopaedics &Amp; Related Research

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“…Mortality 1 y after hip fracture varies from 14 to 37% (Lyons, 1997). Acute hospital costs after hip fracture are substantial, and costs of rehabilitation and care in the community may be greater; respectively, estimated at d4800 and d7500 at 1995/6 prices in the UK (Dolan & Torgerson, 1998).…”

Section: Introductionmentioning

confidence: 99%

A systematic review of protein and energy supplementation for hip fracture aftercare in older people

Avenell

Handoll

2003

Eur J Clin Nutr

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Objectives: To evaluate whether protein and energy supplementation influences recovery after hip fracture. Design: Systematic review of randomised and quasi-randomised trials in people aged 65 y and over. Data sources: We searched seven electronic databases from 1966 to April 2002, four journals and reference lists of relevant articles. We contacted trial investigators and experts for details of other trials. Main outcome measures: Mortality, complications and unfavourable outcome (mortality or survivors with complications) were the primary outcomes. We also sought data on length of hospital stay, functional status after hip fracture, quality of life and compliance with supplementation. Results: In total, 12 randomised trials involving 898 participants were included. Nine trials evaluated protein and energy supplementation (five oral and four nasogastric feeding), and a further three trials tested oral protein supplementation. Potential biases resulting from inadequate allocation concealment and lack of assessor blinding and intention-to-treat analysis, as well as the limited outcome data, mean that the results must be interpreted with caution. Pooled data from eight of the nine trials evaluating protein and energy supplements showed no evidence for an effect on mortality (relative risk 0.92, 95% CI 0.56-1.50). Limited data from only three trials showed that oral protein and energy supplements may reduce unfavourable outcome (relative risk 0.52, 95% CI 0.32-0.84). Conclusion: Based on limited evidence, oral protein and energy supplementation after hip fracture may reduce unfavourable outcome. Further evidence from good-quality randomised trials is required to inform clinical practice.

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“…2 Mortality associated with hip fracture is reported to be 5-10% within 30 days (short-term) and 12-37% within one year (mid-term) after surgery. [1][2][3][4] The Royal College of Physicians' guidelines recommend that surgery be performed within 24 hr after admission 5 because early (vs late) surgical repair is believed to be associated with increased survival; decreased risk of infection, venous thromboembolism or decubitus ulceration; shorter hospital stay; and fewer costs. However, a recent literature review 6 yielded conflicting results on the association between mortality and timing of surgical repair.…”

mentioning

confidence: 99%

“…4 Anesthesiologists also play an important role in prioritizing patients on the surgical waiting list. The authors were therefore motivated to carry out a systematic review of published prospective and retrospective observational studies to determine whether operative delay increases the mortality of elderly patients with hip fracture.…”

mentioning

confidence: 99%

Is operative delay associated with increased mortality of hip fracture patients? Systematic review, meta-analysis, and meta-regression

Shiga

Wajima

Ohe

2008

Can J Anesth/J Can Anesth

555

338

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Purpose: Mortality associated with hip fracture is high in elderly patients. Surgical repair within 24 hr after admission is recommended by The Royal College of Physicians' guidelines; however, the effect of operative delay on mortality remains controversial. The objective of this study was to determine whether operative delay increases mortality in elderly patients with hip fracture. Methods: Published English-language reports examining the effect of surgical delay on mortality in patients who underwent hip surgery were identified from electronic databases. The primary outcome was defined as all-cause mortality at 30 days and at one year. Effect sizes with corresponding 95% confidence intervals were calculated by using a DerSimonian-Laird randomeffects model. Results:Sixteen prospective or retrospective observational studies (257,367 patients) on surgical timing and mortality in hip fracture patients were selected. When a cut-off of 48 hr from the time of admission was used to define operative delay, the odds ratio for 30-day mortality was 1.41 (95% CI = 1.29-1.54, P < 0.001), and that for one-year mortality was 1.32 (95% CI = 1.21-1.43, P < 0.001). Conclusions: In hip fracture patients, operative delay beyond 48 hr after admission may increase the odds of 30-day all-cause mortality by 41% and of one-year all-cause mortality by 32%. Potential residual confounding factors in observational studies may limit definitive conclusions. Although routine surgery within 48 hr after admission is hard to achieve in most facilities, anesthesiologists must be aware that an undue delay may be harmful to hip fracture patients, especially those at relatively low risk or those who are young.

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Clinical outcomes and treatment of hip fractures

Cited by 207 publications

References 79 publications

Predictors of Prognosis for Elderly Patients with Poststroke Hemiplegia Experiencing Hip Fractures

Predictors of Prognosis for Elderly Patients with Poststroke Hemiplegia Experiencing Hip Fractures

A systematic review of protein and energy supplementation for hip fracture aftercare in older people

Is operative delay associated with increased mortality of hip fracture patients? Systematic review, meta-analysis, and meta-regression

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