Hip fractures in elderly people: Surgery or no surgery? A systematic review and meta-analysis

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

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Abstract

Iintroduction: 

Increasing numbers of patients with hip fractures also have advanced comorbidities. A majority are treated surgically. However, a significantly increasing percentage of medically unfit patients with unacceptably high risk of perioperative death are treated nonoperatively. Important questions about patients' prefracture quality of life (QOL) and future perspectives should be asked before considering different treatment options to assess what kind of treatment is advisable in frail elderly high-risk patients with a hip fracture.

Objective: 

The aim of this review was to provide an overview of differences in mortality, health-related QOL [(HR)QOL], functional outcome, and costs between nonoperative management (NOM) and operative management (OM) of hip fractures in patients above 65 years.

Methods: 

A systematic literature search was performed in EMBASE, OvidSP, PubMed, Cochrane Central, and Web of Science for observational studies and trials. Observational studies and randomized controlled trials comparing NOM with OM in hip fracture patients were selected. The methodological quality of the selected studies was assessed according to the Methodological Index for Nonrandomized Studies (MINORS) or Furlan checklist.

Results: 

Seven observational studies were included with a total of 1189 patients, of whom 242 (20.3%) were treated conservatively. The methodological quality of the studies was moderate (mean: 14.7, standard deviation [SD]: 1.5). The 30-day and 1-year mortalities were higher in the nonoperative group (odds ratio [OR]: 3.95, 95% confidence interval [CI]: 1.43-10.96; OR: 3.84, 95% CI: 1.57-9.41). None of the included studies compared QOL, functional outcome, or health-care costs between the 2 groups.

Conclusion: 

This systematic review and meta-analysis demonstrated that only a few studies with small number of patients comparing NOM with OM were published. A significantly higher 30-day and 1-year mortality was revealed in nonoperatively treated hip fracture patients. No data were found examining (HR)QOL and costs. Further work is needed to enable shared decision-making and to initiate NOM in frail elderly patients with advanced comorbidity and limited life expectancy.

Original languageEnglish
Pages (from-to)173-180
JournalGeriatric orthopaedic surgery & rehabilitation
Volume8
Issue number3
DOIs
Publication statusPublished - 2017

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Keywords

  • Journal Article
  • Review

Cite this

@article{e7b8951508c04ebdb1e463f5f6042026,
title = "Hip fractures in elderly people: Surgery or no surgery? A systematic review and meta-analysis",
abstract = "Iintroduction: Increasing numbers of patients with hip fractures also have advanced comorbidities. A majority are treated surgically. However, a significantly increasing percentage of medically unfit patients with unacceptably high risk of perioperative death are treated nonoperatively. Important questions about patients' prefracture quality of life (QOL) and future perspectives should be asked before considering different treatment options to assess what kind of treatment is advisable in frail elderly high-risk patients with a hip fracture.Objective: The aim of this review was to provide an overview of differences in mortality, health-related QOL [(HR)QOL], functional outcome, and costs between nonoperative management (NOM) and operative management (OM) of hip fractures in patients above 65 years.Methods: A systematic literature search was performed in EMBASE, OvidSP, PubMed, Cochrane Central, and Web of Science for observational studies and trials. Observational studies and randomized controlled trials comparing NOM with OM in hip fracture patients were selected. The methodological quality of the selected studies was assessed according to the Methodological Index for Nonrandomized Studies (MINORS) or Furlan checklist.Results: Seven observational studies were included with a total of 1189 patients, of whom 242 (20.3{\%}) were treated conservatively. The methodological quality of the studies was moderate (mean: 14.7, standard deviation [SD]: 1.5). The 30-day and 1-year mortalities were higher in the nonoperative group (odds ratio [OR]: 3.95, 95{\%} confidence interval [CI]: 1.43-10.96; OR: 3.84, 95{\%} CI: 1.57-9.41). None of the included studies compared QOL, functional outcome, or health-care costs between the 2 groups.Conclusion: This systematic review and meta-analysis demonstrated that only a few studies with small number of patients comparing NOM with OM were published. A significantly higher 30-day and 1-year mortality was revealed in nonoperatively treated hip fracture patients. No data were found examining (HR)QOL and costs. Further work is needed to enable shared decision-making and to initiate NOM in frail elderly patients with advanced comorbidity and limited life expectancy.",
keywords = "Journal Article, Review",
author = "{van de Ree}, C.L.P. and {de Jongh}, M.A.C. and Peeters, {Charles M M} and {de Munter}, Leonie and Roukema, {Jan A} and Taco Gosens",
year = "2017",
doi = "10.1177/2151458517713821",
language = "English",
volume = "8",
pages = "173--180",
journal = "Geriatric orthopaedic surgery & rehabilitation",
issn = "2151-4585",
publisher = "SAGE Publications Inc.",
number = "3",

}

Hip fractures in elderly people : Surgery or no surgery? A systematic review and meta-analysis. / van de Ree, C.L.P.; de Jongh, M.A.C.; Peeters, Charles M M; de Munter, Leonie; Roukema, Jan A; Gosens, Taco.

In: Geriatric orthopaedic surgery & rehabilitation, Vol. 8, No. 3, 2017, p. 173-180.

Research output: Contribution to journalArticleScientificpeer-review

TY - JOUR

T1 - Hip fractures in elderly people

T2 - Surgery or no surgery? A systematic review and meta-analysis

AU - van de Ree, C.L.P.

AU - de Jongh, M.A.C.

AU - Peeters, Charles M M

AU - de Munter, Leonie

AU - Roukema, Jan A

AU - Gosens, Taco

PY - 2017

Y1 - 2017

N2 - Iintroduction: Increasing numbers of patients with hip fractures also have advanced comorbidities. A majority are treated surgically. However, a significantly increasing percentage of medically unfit patients with unacceptably high risk of perioperative death are treated nonoperatively. Important questions about patients' prefracture quality of life (QOL) and future perspectives should be asked before considering different treatment options to assess what kind of treatment is advisable in frail elderly high-risk patients with a hip fracture.Objective: The aim of this review was to provide an overview of differences in mortality, health-related QOL [(HR)QOL], functional outcome, and costs between nonoperative management (NOM) and operative management (OM) of hip fractures in patients above 65 years.Methods: A systematic literature search was performed in EMBASE, OvidSP, PubMed, Cochrane Central, and Web of Science for observational studies and trials. Observational studies and randomized controlled trials comparing NOM with OM in hip fracture patients were selected. The methodological quality of the selected studies was assessed according to the Methodological Index for Nonrandomized Studies (MINORS) or Furlan checklist.Results: Seven observational studies were included with a total of 1189 patients, of whom 242 (20.3%) were treated conservatively. The methodological quality of the studies was moderate (mean: 14.7, standard deviation [SD]: 1.5). The 30-day and 1-year mortalities were higher in the nonoperative group (odds ratio [OR]: 3.95, 95% confidence interval [CI]: 1.43-10.96; OR: 3.84, 95% CI: 1.57-9.41). None of the included studies compared QOL, functional outcome, or health-care costs between the 2 groups.Conclusion: This systematic review and meta-analysis demonstrated that only a few studies with small number of patients comparing NOM with OM were published. A significantly higher 30-day and 1-year mortality was revealed in nonoperatively treated hip fracture patients. No data were found examining (HR)QOL and costs. Further work is needed to enable shared decision-making and to initiate NOM in frail elderly patients with advanced comorbidity and limited life expectancy.

AB - Iintroduction: Increasing numbers of patients with hip fractures also have advanced comorbidities. A majority are treated surgically. However, a significantly increasing percentage of medically unfit patients with unacceptably high risk of perioperative death are treated nonoperatively. Important questions about patients' prefracture quality of life (QOL) and future perspectives should be asked before considering different treatment options to assess what kind of treatment is advisable in frail elderly high-risk patients with a hip fracture.Objective: The aim of this review was to provide an overview of differences in mortality, health-related QOL [(HR)QOL], functional outcome, and costs between nonoperative management (NOM) and operative management (OM) of hip fractures in patients above 65 years.Methods: A systematic literature search was performed in EMBASE, OvidSP, PubMed, Cochrane Central, and Web of Science for observational studies and trials. Observational studies and randomized controlled trials comparing NOM with OM in hip fracture patients were selected. The methodological quality of the selected studies was assessed according to the Methodological Index for Nonrandomized Studies (MINORS) or Furlan checklist.Results: Seven observational studies were included with a total of 1189 patients, of whom 242 (20.3%) were treated conservatively. The methodological quality of the studies was moderate (mean: 14.7, standard deviation [SD]: 1.5). The 30-day and 1-year mortalities were higher in the nonoperative group (odds ratio [OR]: 3.95, 95% confidence interval [CI]: 1.43-10.96; OR: 3.84, 95% CI: 1.57-9.41). None of the included studies compared QOL, functional outcome, or health-care costs between the 2 groups.Conclusion: This systematic review and meta-analysis demonstrated that only a few studies with small number of patients comparing NOM with OM were published. A significantly higher 30-day and 1-year mortality was revealed in nonoperatively treated hip fracture patients. No data were found examining (HR)QOL and costs. Further work is needed to enable shared decision-making and to initiate NOM in frail elderly patients with advanced comorbidity and limited life expectancy.

KW - Journal Article

KW - Review

U2 - 10.1177/2151458517713821

DO - 10.1177/2151458517713821

M3 - Article

C2 - 28835875

VL - 8

SP - 173

EP - 180

JO - Geriatric orthopaedic surgery & rehabilitation

JF - Geriatric orthopaedic surgery & rehabilitation

SN - 2151-4585

IS - 3

ER -