Hip Fractures in Elderly People: Surgery or No Surgery? A Systematic Review and Meta-Analysis

Ree, Cornelis L. P. van de; Jongh, Mariska A. C. de; Peeters, Charles M M; Munter, Leonie de; Roukema, Jan A.; Gosens, Taco

doi:10.1177/2151458517713821

Cited by 69 publications

(69 citation statements)

References 26 publications

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“…A recent systematic review demonstrated very few studies comparing operative and nonoperative management. 33 The available work focuses on mortality and not quality of life or health-care costs. Six patients in our mortality group did not receive a procedure following a consensus decision from the MDT.…”

Section: Discussionmentioning

confidence: 99%

Is There a Role for Early Palliative Intervention in Frail Older Patients With a Neck of Femur Fracture?

Davies

Tilston

Walsh

et al. 2018

Geriatr Orthop Surg Rehabil

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Background:Patients with a neck of femur fracture have a high mortality rate. National outcomes have improved significantly as the management of this patient group is prioritized. In 2016, however, 4398 (6.7%) patients died within 30 days of admission.Objective:To investigate whether palliative care could be integrated early in the care plan for high-risk patients.Methods:All cases of inpatient mortality following neck of femur fracture at North Bristol Major Trauma Centre over a 24-month period were reviewed. A comprehensive assessment of care was performed from the emergency department until death. All investigations, interventions, and management decisions were recorded. A consensus decision regarding expected mortality was made for each case at a multidisciplinary meeting which included surgical, orthogeriatric, nursing, and anesthetic team input.Results:A total of 1033 patients were admitted following a neck of femur fracture. There were 74 inpatient deaths, and 82% were considered predictable at our multidisciplinary meeting. The mean length of stay was 18 days (range: 0-85, median 14). In 42% of cases, mortality was considered predictable on admission, and 40% were considered predictable following acute deterioration. These patients received on average 28 blood tests (range: 4-114) and 6.8 X-rays and computed tomographies (range: 2-20). Of this, 66% received end-of-life care; mean duration 2.3 days (range: 0-17).Conclusions:Mortality rates remain high in a subset of patients. This study demonstrates that intensive investigation and medical management frequently continues until death, including in patients with predictably poor outcomes. Early palliative care input has been integrated successfully into patient management in other specialties. We demonstrate that it is feasible to identify patients with hip fracture who may benefit from this expertise.

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Section: Discussionmentioning

confidence: 99%

Is There a Role for Early Palliative Intervention in Frail Older Patients With a Neck of Femur Fracture?

Davies

Tilston

Walsh

et al. 2018

Geriatr Orthop Surg Rehabil

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“…24 A significantly higher 30-day and 1-year mortality was revealed in nonoperatively treated hip fracture patients. 25 Operating on patients older than 100 years carries an acceptable mortality rate. Age alone should not preclude centenarians from undergoing operative treatment for hip fractures.…”

Section: To Perform Surgery or Not?mentioning

confidence: 99%

Perioperative management of geriatric patients for orthopedic surgeries

Krishna

Pathak

2020

Int J Res Orthop

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<p class="abstract">With increasing life expectancy, the mean age of patient orthopedicians and anesthesiologists have to deal with is increasing. In this review article, we discuss the case management of three centurions aged 110, 105 and 102 years respectively who underwent lower limb orthopedic surgery under nerve block, general anesthesia and neuraxial blockade, and elaborate on the various issues faced perioperatively by the treating team. The challenges and differences faced in perioperative period in geriatric anesthesia were discussed and literature reviewed for the benefit of the operating surgeons.</p>

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“…Different treatment options exist for each of these diagnoses, and the treatment is guided by patients' presenting symptoms and clinical expertise of the physician. It usually involves shared decision making between surgeon, cardiologist, and the patient [4,5]. The purpose of this review is to highlight the current literature available in these scenarios to help guide physicians about the current standard of care for these patients.…”

Section: Introductionmentioning

confidence: 99%

The Management Dilemma: Concomitant Acute Hip Fracture and Severe Asymptomatic Aortic Stenosis

Ahmed¹,

Safdar²

2020

Cureus

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Acute hip fractures (AHF) are common in elderly patients. A combination of age-related osteoporosis and increased fall risk makes this population group most susceptible to different fractures including acute fracture of the hip. AHF is a disabling condition that warrants immediate attention. It has a huge impact on the already compromised baseline functional status of elderly patients rendering them more susceptible to different morbidities and even mortality. Similarly, age-related degeneration of the aortic valve with resulting calcification also makes elderly patients prone to aortic stenosis (AS). Severe asymptomatic AS when diagnosed in these patients with AHF in the perioperative period makes the management options very challenging. Severity of AS usually translates into worse postoperative outcomes. The management rationale of concomitant presence of these two conditions is unclear. There is a lack of clear-cut recommendations and societal guidelines in such scenario.

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Hip Fractures in Elderly People: Surgery or No Surgery? A Systematic Review and Meta-Analysis

Cited by 69 publications

References 26 publications

Is There a Role for Early Palliative Intervention in Frail Older Patients With a Neck of Femur Fracture?

Is There a Role for Early Palliative Intervention in Frail Older Patients With a Neck of Femur Fracture?

Perioperative management of geriatric patients for orthopedic surgeries

The Management Dilemma: Concomitant Acute Hip Fracture and Severe Asymptomatic Aortic Stenosis

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