Perioperative fluid volume optimization following proximal femoral fracture

Abstract

BackgroundProximal femoral fracture (PFF) is a common orthopaedic emergency, affecting mainly elderly people at high risk of complications. Advanced methods for managing fluid therapy during treatment for PFF are available, but their role in reducing risk is unclear. ObjectivesTo compare the safety and effectiveness of different methods of perioperative fluid optimization in adult participants undergoing surgical repair of hip fracture. We considered the following methods: advanced invasive haemodynamic monitoring, such as transoesophageal Doppler and pulse contour analysis; a protocol using standard measures, such as blood pressure, urine output and central venous pressure; and usual care.Comparisons of fluid types (e.g. crystalloid vs colloid) and other methods of optimizing oxygen delivery, such as blood product therapies and pharmacological treatment with inotropes and vasoactive drugs, are considered elsewhere. Search methodsWe searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 9); MEDLINE (1966 to October 2012); and EMBASE (1980 to October 2012) without language restrictions. We ran forward and backward citation searches on identified trials. We contacted authors and searched ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform for unpublished trials. This is an updated version of a review published in 2004. The original search was performed in October 2003. Selection criteriaWe included randomized controlled trials (RCTs) in adult participants undergoing surgical treatment for PFF, which compared any two of advanced haemodynamic monitoring, protocols using standard measures or usual care, irrespective of blinding, language or publication status. Data collection and analysisTwo review authors assessed the impact of fluid optimization interventions on outcomes of mortality, length of hospital stay, return of participant to pre-fracture accommodation and mobility at six months and adverse events in hospital. We pooled data using risk ratio or mean difference for dichotomous or continuous data, respectively, based on random-effects models. Perioperative fluid volume optimization following proximal femoral fracture (Review)

A randomised trial of non-invasive cardiac output monitoring to guide haemodynamic optimisation in high risk patients undergoing urgent surgical repair of proximal femoral fractures (ClearNOF trial NCT02382185)

“…We used the same search strategy published in the Cochrane review (Brammar et al, 2013) and the paper by Moppett (Moppett et al, 2015) to update the meta-analysis using identical search criteria in Cochrane, Medline, EMBASE and trial registries (clinicaltrials.gov and WHO). Searches were carried out on 20 November 2018 and repeated on the 6 June 2019.…”

A randomised trial of non-invasive cardiac output monitoring to guide haemodynamic optimisation in high risk patients undergoing urgent surgical repair of proximal femoral fractures (ClearNOF trial NCT02382185)

“…We used the same search strategy published in the Cochrane review (Brammar et al, 2013) and the paper by Moppett (Moppett et al, 2015) to update the meta-analysis using identical search criteria in Cochrane, Medline, EMBASE and trial registries (clinicaltrials.gov and WHO). Searches were carried out on 20 November 2018 and repeated on the 6 June 2019.…”

Effect of comorbidities on the association between age and hospital mortality after fall-related hip fracture in elderly patients

“…According to the last Cochrane revision [23] it is advisable that future studies analyze the optimal perioperative management protocol of fluid and electrolyte replacement in hip fracture surgical patients that could improve their outcome. That recommendation appears to be supported by our results.…”

Enhanced Recovery for Neck of Femur Fracture: A Current Concept and Review of Perioperative Interventions

“…Although currently the evidence is not conclusive as to whether a adverse events [53] . One trial did however come to a conclusion that those patients undergoing intensive fluid management had a significantly decreased LOS in hospital (6.2 day reduction) compared with a standard protocol for fluid management (3.9 day reduction) in patients undergoing proximal femur repair [54] .…”

“…One trial did however come to a conclusion that those patients undergoing intensive fluid management had a significantly decreased LOS in hospital (6.2 day reduction) compared with a standard protocol for fluid management (3.9 day reduction) in patients undergoing proximal femur repair [54] . The review concluded that although one study did show a decrease in the LOS in hospital, the evidence was not strong enough to recommend [53] . Further evidence is required.…”

A randomised trial of non-invasive cardiac output monitoring to guide haemodynamic optimisation in high risk patients undergoing urgent surgical repair of proximal femoral fractures (ClearNOF trial NCT02382185)

“…We used the same search strategy published in the Cochrane review (Brammar et al, 2013) and the paper by Moppett (Moppett et al, 2015) to update the meta-analysis using identical search criteria in Cochrane, Medline, EMBASE and trial registries (clinicaltrials.gov and WHO). Searches were carried out on 20 November 2018 and repeated on the 6 June 2019.…”

Effect of comorbidities on the association between age and hospital mortality after fall-related hip fracture in elderly patients

“…According to the last Cochrane revision [23] it is advisable that future studies analyze the optimal perioperative management protocol of fluid and electrolyte replacement in hip fracture surgical patients that could improve their outcome. That recommendation appears to be supported by our results.…”

Enhanced Recovery for Neck of Femur Fracture: A Current Concept and Review of Perioperative Interventions

“…Although currently the evidence is not conclusive as to whether a adverse events [53] . One trial did however come to a conclusion that those patients undergoing intensive fluid management had a significantly decreased LOS in hospital (6.2 day reduction) compared with a standard protocol for fluid management (3.9 day reduction) in patients undergoing proximal femur repair [54] .…”

“…One trial did however come to a conclusion that those patients undergoing intensive fluid management had a significantly decreased LOS in hospital (6.2 day reduction) compared with a standard protocol for fluid management (3.9 day reduction) in patients undergoing proximal femur repair [54] . The review concluded that although one study did show a decrease in the LOS in hospital, the evidence was not strong enough to recommend [53] . Further evidence is required.…”

A randomised trial of non-invasive cardiac output monitoring to guide haemodynamic optimisation in high risk patients undergoing urgent surgical repair of proximal femoral fractures (ClearNOF trial NCT02382185)

“…We used the same search strategy published in the Cochrane review (Brammar et al, 2013) and the paper by Moppett (Moppett et al, 2015) to update the meta-analysis using identical search criteria in Cochrane, Medline, EMBASE and trial registries (clinicaltrials.gov and WHO). Searches were carried out on 20 November 2018 and repeated on the 6 June 2019.…”

Effect of comorbidities on the association between age and hospital mortality after fall-related hip fracture in elderly patients

“…According to the last Cochrane revision [23] it is advisable that future studies analyze the optimal perioperative management protocol of fluid and electrolyte replacement in hip fracture surgical patients that could improve their outcome. That recommendation appears to be supported by our results.…”

Enhanced Recovery for Neck of Femur Fracture: A Current Concept and Review of Perioperative Interventions

“…Although currently the evidence is not conclusive as to whether a adverse events [53] . One trial did however come to a conclusion that those patients undergoing intensive fluid management had a significantly decreased LOS in hospital (6.2 day reduction) compared with a standard protocol for fluid management (3.9 day reduction) in patients undergoing proximal femur repair [54] .…”

“…One trial did however come to a conclusion that those patients undergoing intensive fluid management had a significantly decreased LOS in hospital (6.2 day reduction) compared with a standard protocol for fluid management (3.9 day reduction) in patients undergoing proximal femur repair [54] . The review concluded that although one study did show a decrease in the LOS in hospital, the evidence was not strong enough to recommend [53] . Further evidence is required.…”