Department of Population Health Sciences, School of Population Health and Environmental Sciences, King's College London, London, UK.
Department of Orthopaedic Surgery, Duke University Medical Centre, Durham, NC, USA.
Osteoporos Int. 2019 Jul;30(7):1339-1351. doi: 10.1007/s00198-019-04976-x. Epub 2019 Apr 29.
To examine prognostic factors that influence complications after hip fracture surgery. To summarize proposed underlying mechanisms for their influence.
We reported according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Scoping Review extension. We searched MEDLINE, Embase, CINAHL, AgeLine, Cochrane Library, and reference lists of retrieved studies for studies of prognostic factor/s of postoperative in-hospital medical complication/s among patients 50 years and older treated surgically for non-pathological closed hip fracture, published in English on January 2008-January 2018. We excluded studies of surgery type or in-hospital medications. Screening was duplicated by two independent reviewers. One reviewer completed the extraction with accuracy checks by the second reviewer. We summarized the extent, nature, and proposed underlying mechanisms for the prognostic factors of complications narratively and in a dependency graph.
We identified 44 prognostic factors of in-hospital complications after hip fracture surgery from 56 studies. Of these, we identified 7 patient factors-dehydration, anemia, hypotension, heart rate variability, pressure risk, nutrition, and indwelling catheter use; and 7 process factors-time to surgery, anesthetic type, transfusion strategy, orthopedic versus geriatric/co-managed care, multidisciplinary care pathway, and potentially modifiable during index hospitalization. We identified underlying mechanisms for 15 of 44 factors. The reported association between 12 prognostic factors and complications was inconsistent across studies.
Most factors were reported by one study with no proposed underlying mechanism for their influence. Where reported by more than one study, there was inconsistency in reported associations and the conceptualization of complications differed, limiting comparison across studies. It is therefore not possible to be certain whether intervening on these factors would reduce the rate of complications after hip fracture surgery.
探讨影响髋部骨折手术后并发症的预后因素。总结其影响的潜在机制。
我们根据系统评价和荟萃分析扩展的首选报告项目进行了报告。我们检索了 MEDLINE、Embase、CINAHL、AgeLine、Cochrane 图书馆以及检索研究的参考文献，以寻找 50 岁及以上接受手术治疗的非病理性闭合性髋部骨折患者术后住院期间医疗并发症的预后因素研究，这些研究发表于 2008 年 1 月至 2018 年 1 月期间，使用英文。我们排除了手术类型或住院期间药物治疗的研究。两位独立的审查员进行了重复筛选。一位审查员在准确性检查的协助下完成了提取工作。我们以叙述和依赖图的形式总结了并发症的预后因素的程度、性质和潜在机制。
我们从 56 项研究中确定了 44 个与髋部骨折手术后住院并发症相关的预后因素。其中，我们确定了 7 个患者因素（脱水、贫血、低血压、心率变异性、压力风险、营养和留置导管使用）和 7 个过程因素（手术时间、麻醉类型、输血策略、骨科与老年科/联合管理、多学科护理途径，以及在指数住院期间可能改变）。我们确定了 44 个因素中的 15 个的潜在机制。12 个预后因素与并发症之间的关联在研究之间不一致。
大多数因素仅由一项研究报告，且没有关于其影响的潜在机制。在有多项研究报告的情况下，报告的相关性不一致，并发症的概念也不同，限制了研究之间的比较。因此，无法确定干预这些因素是否会降低髋部骨折手术后并发症的发生率。
