Medical College, Nankai University, 94 Weijin Road, Tianjin 300071, China.
Injury. 2012 Jun;43(6):676-85. doi: 10.1016/j.injury.2011.05.017. Epub 2011 Jun 17.
Hip fractures are always associated with a high postoperative mortality, the preoperative predictors for mortality have neither been well identified or summarised. This systematic review and meta-analysis was performed to identify the preoperative non-interventional predictors for mortality in hip fracture patients, especially focused on 1 year mortality.
Non-interventional studies were searched in Pubmed, Embase, Cochrane central database (all to February 26th, 2011). Only prospective studies and retrospective studies with prospective collected data were included. Qualities of included studies were assessed by a standardised scale previous reported for observational studies. The effects of individual studies were combined with the study quality score using a previous reported model of best-evidence synthesis. The hazard ratios of strong evidence predictors were combined only by high quality studies.
75 included studies with 94 publications involving 64,316 patients were included and the available observations was a heterogeneous group. The overall inpatient or 1 month mortality was 13.3%, 3-6 months was 15.8%, 1 year 24.5% and 2 years 34.5%. There were strong evidence for 12 predictors, including advanced age, male gender, nursing home or facility residence, poor preoperative walking capacity, poor activities of daily living, higher ASA grading, poor mental state, multiple comorbidities, dementia or cognitive impairment, diabetes, cancer and cardiac disease. We also identified 7 moderate evidence and 12 limited evidence mortality predictors, and only the race was identified as the conflicting evidence predictor.
Whilst there is no conclusive evidence of the preoperative predictors for mortality following hip fractures, special attention should be paid to the above 12 strong evidence predictors. Future researches were still needed to evaluate the effects of these predictors.
髋部骨折总是与高术后死亡率相关，术前预测死亡率的因素尚未得到很好的确定或总结。本系统评价和荟萃分析旨在确定髋部骨折患者术后死亡率的术前非干预性预测因素，特别是重点关注 1 年死亡率。
在 Pubmed、Embase 和 Cochrane 中心数据库（均截至 2011 年 2 月 26 日）中搜索非干预性研究。仅纳入前瞻性研究和前瞻性收集数据的回顾性研究。纳入研究的质量采用先前报道的观察性研究标准量表进行评估。使用先前报道的最佳证据综合模型，将研究质量评分与个体研究的效果相结合。仅对高质量研究进行合并有强证据预测因子的风险比。
共纳入 75 项研究，94 篇文献，涉及 64316 例患者，可利用的观察结果为异质性群体。总的住院或 1 个月死亡率为 13.3%，3-6 个月为 15.8%，1 年为 24.5%，2 年为 34.5%。有 12 个预测因素具有强证据，包括年龄较大、男性、养老院或医疗机构居住、术前行走能力差、日常生活活动能力差、ASA 分级较高、精神状态差、合并多种疾病、痴呆或认知障碍、糖尿病、癌症和心脏病。我们还确定了 7 个中度证据和 12 个有限证据的死亡率预测因素，只有种族被确定为相互矛盾的证据预测因素。
虽然没有髋部骨折后死亡率的术前预测因素的明确证据，但应特别注意上述 12 个强证据预测因素。未来仍需要研究来评估这些预测因素的影响。
