Comparative assessment of early versus delayed surgery to treat proximal femoral fractures in elderly patients: A systematic review and meta-analysis

Chen, Peng; Shen, Xiaotian; Xu, Weimin; Yao, Wanglin; Ma, Ning

doi:10.1016/j.ijsu.2019.06.013

Cited by 13 publications

(10 citation statements)

References 43 publications

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“…Previous systematic reviews have demonstrated clear survival benefits of performing hip fracture surgery within 48 hrs of admission, compared with surgery performed beyond 48 hrs. (5,65) Advantages of operating within 24 hrs, however, have been less obvious. The most recent review on the topic by Chen et al reported significantly improved survival for patients operated within 24 hours at one year (RR 0.68, 0.56-0.84), but not at 30 days (RR 1.05, 0.90-1.22).…”

Section: Discussionmentioning

confidence: 99%

“…Our search strategy identified several studies that were not included in previous meta-analyses on this subject. (4,5,65) In contrast to previous reviews, we employed a strict definition for time to surgery. To meet criteria for inclusion, studies were required to state explicitly that time-to-surgery was measured in hours rather than calendar days.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

“…(2,3) In contrast, earlier surgical treatment is, to some extent, a modifiable factor that may reduce mortality following hip fracture. (4,5) An acceptable definition of 'early surgery', however, is widely debated, varying from 6-72 hrs (hours). (6) As a result, national guidance on when to perform surgery following hip fracture varies.…”

Section: Introductionmentioning

confidence: 99%

“…A previous meta-analysis demonstrated improved survival at 1 year following hip fracture surgery performed within 24 hrs of admission. (5) Since then, several high-quality registry studies have been published. (11)(12)(13)(14) An updated analysis of existing data is therefore required to review and inform guidelines for the management of hip fractures.…”

Section: Introductionmentioning

confidence: 99%

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The association between surgical fixation of hip fractures within 24 hours and mortality

Welford

Jones

Davies

et al. 2021

The Bone & Joint Journal

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Aims The aim of this study was to assess the effect of time to surgical intervention from admission on mortality and morbidity for patients with hip fractures. Methods MEDLINE and Embase were searched from inception to June 2020. Reference lists were manually assessed to identify additional papers. Primary comparative research studies that recruited patients aged over 60 years, with non-pathological primary proximal femoral fractures that were treated surgically, were included. Studies that did not include a group operated on within 24 hours or which reported time to surgery in calendar days were excluded. Two investigators extracted data on study characteristics, methods, and outcomes. The pre-defined primary outcome was 30-day mortality. Secondary outcomes were complications and mortality at other time points. Relative risks (RRs) with 95% confidence intervals (CIs) were aggregated and were grouped by study-level characteristics. Results This review included 46 studies (January 1991 to June 2020), comprising 521,857 hip fractures with 64,047 postoperative deaths. No randomized controlled trials were eligible for inclusion. In a pooled analysis of 15 studies, RR of mortality at 30 days comparing time to surgery < 24 hours with > 24 hours was 0.86 (95% CI 0.82 to 0.91; I 2 = 69%; 95% CI 50% to 81%; p-value for heterogeneity < 0.001). The association was stronger in observational studies that did not adjust for confounders than in those that adjusted for multiple covariates. In a pooled analysis of six studies, the RR of mortality at 30 days comparing time to surgery < 24 hours with 24 to 36 hours was 0.87 (95% CI 0.81 to 0.93; I 2 = 65%; 95% CI 16% to 85%; p-value for heterogeneity = 0.014). Conclusion This meta-analysis indicates reduced mortality for patients operated within 24 hours compared with those operated on beyond 24 hours or within 24 to 36 hours. Where resources allow and there is no specific reversible contraindication to early surgery, we recommend that hip fractures should be surgically treated within 24 hours. Cite this article: Bone Joint J 2021;103-B(7):1176–1186.

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Section: Discussionmentioning

confidence: 99%

Section: Strengths and Limitationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The association between surgical fixation of hip fractures within 24 hours and mortality

Welford

Jones

Davies

et al. 2021

The Bone & Joint Journal

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“…O risco de morte é aumentado quando existe atraso da cirurgia maior do que 48 horas. A redução do tempo de abordagem cirúrgica é um fator no qual o cirurgião pode interferir, diminuindo assim o risco de complicações e a mortalidade (8)(9) .…”

Section: Introductionunclassified

Fratura de fêmur nos idosos: tempo de espera cirúrgica e desfecho da hospitalização

Alcantara

Dellaroza²,

Ribeiro³

et al. 2021

Cienc. Cuid. Saúde

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Objetivo: Analisar o tempo de espera para correção de fratura de fêmur, seus fatores associados e o desfecho de hospitalização. Método: Transversal exploratório, com a população de idosos ≥60 anos internados por fratura de fêmur no período de 2015 a 2017. Os dados foram coletados através do prontuário físico, comanálises estatísticas considerando o nível de significância estatística de p<0,05. Resultados: Dos idosos estudados, 61,4% correspondem ao sexo feminino. Aqueles que permaneceram por mais do que sete dias à espera de cirurgia se associaram ao tempo de hospitalização maior do que 10 dias, lesão por pressão (p<0,001) e ao desfecho óbito (p=0,003). A média de permanência hospitalar foi de 13,8 dias e do tempo esperadopela cirurgia de 6,6 dias. A espera da realização do risco cirúrgico e vaga em unidade de terapia intensiva foram fatores que provocaram atraso na realização da cirurgia em 23,2% dos idosos. Conclusão: Esperar pela cirurgia por mais de sete dias aumentou o tempo de permanência hospitalar e a taxa de mortalidade. Além disso, a ausência de vaga de terapia intensiva e a espera pelo risco cirúrgico contribuíram para o atraso da cirurgia e seu desfecho.

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Biomedical Applications of Dextran

Sharma,

Jagadeesh Chandra Bose

2024

Biopolymers for Biomedical Applications

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Comparative assessment of early versus delayed surgery to treat proximal femoral fractures in elderly patients: A systematic review and meta-analysis

Cited by 13 publications

References 43 publications

The association between surgical fixation of hip fractures within 24 hours and mortality

The association between surgical fixation of hip fractures within 24 hours and mortality

Fratura de fêmur nos idosos: tempo de espera cirúrgica e desfecho da hospitalização

Biomedical Applications of Dextran

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