Department of Surgery, Northwest Clinics, P.O Box 501, 1800 AM Alkmaar, Netherlands; Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, Netherlands.
Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, Netherlands.
Injury. 2020 Nov;51(11):2407-2413. doi: 10.1016/j.injury.2020.08.027. Epub 2020 Aug 23.
Hip fractures in frail elderly patients are associated with significant mortality and morbidity. Surgery remains the predominant treatment of choice, despite the poor prognosis. Limited research has been done with regards to nonoperative management of frail elderly patients with a hip fracture and therefore the natural course is relatively unknown. This systematic review aimed to provide an overview of the prognosis of nonoperative management in frail elderly patients with a hip fracture in terms of mortality, complications, mobility, and quality of life (QoL).
A systematic review of the literature was conducted in PubMed, EMBASE, and Cochrane Central. In addition, a meta-analysis was performed. The primary outcome measurement was 30-days mortality.
A total of 4,318 studies were screened. In total eighteen studies matched the eligibility criteria; with low to moderate quality. Approximately two-thirds of the patients were managed nonoperatively due to medical reasons and one-third due to non-medical reasons. Pooled mortality rates after 30 days, six months and one year were 36%, 46%, and 60%, respectively. 33% of the patients developed in-hospital complications. At six months post trauma, 9.6% of the patients were able to mobilize. Data on quality of life (QoL), functional outcome, pain, comfort during nursing care, and costs were not reported.
Nonoperative management of frail elderly patients with a hip fracture is associated with a poor prognosis. Heterogenous study cohorts and limited outcomes were reported. Current literature shows a lack of evidence of the true prognosis of nonoperative management of frail elderly patient with a hip fracture and a limited life expectancy. Results of this review can be used to aid decision making and improve expectation management.
虚弱老年患者髋部骨折与较高的病死率和发病率相关。尽管预后较差，手术仍然是主要的治疗选择。对于虚弱老年髋部骨折患者的非手术治疗，研究有限，因此自然病程相对未知。本系统评价旨在综述非手术治疗虚弱老年髋部骨折患者的预后，包括病死率、并发症、活动能力和生活质量（QoL）。
对 PubMed、EMBASE 和 Cochrane Central 进行文献系统评价，并进行荟萃分析。主要结局测量为 30 天病死率。
共筛选出 4318 项研究。共有 18 项研究符合纳入标准，但质量为低至中度。大约三分之二的患者因医疗原因而非手术治疗，三分之一因非医疗原因而非手术治疗。30 天、6 个月和 1 年的死亡率分别为 36%、46%和 60%。33%的患者发生院内并发症。创伤后 6 个月，9.6%的患者能够活动。未报告生活质量（QoL）、功能结局、疼痛、护理期间舒适度和成本的数据。
对于虚弱老年髋部骨折患者，非手术治疗的预后较差。报告的研究队列异质性较大，结局有限。目前的文献表明，缺乏非手术治疗虚弱老年髋部骨折患者真实预后的证据，预期寿命有限。本综述的结果可用于辅助决策和改善预期管理。
