Yavuz Veizi Betül Gülsüm, Veizi Enejd, Koutserimpas Christos
Ankara Onkoloji Eğitim ve Araştırma Hastanesi, Ankara, Turkey.
Ankara Yıldırım Beyazıt University, Ankara, Turkey.
Arch Orthop Trauma Surg. 2025 Jul 21;145(1):382. doi: 10.1007/s00402-025-05993-8.
Hip fractures have a significant impact on morbidity and mortality in older adults, often leading to loss of function and an increased healthcare burden. The role of geriatric co-management in improving postoperative outcomes remains controversial. This meta-analysis evaluates the impact of geriatric care on functional recovery, complications, length of hospital stay, and one-year mortality in older patients with hip fractures.
A meta-analysis was conducted according to PRISMA guidelines. Randomized controlled trials (RCTs) and prospective cohort studies comparing standard orthopedic care with geriatric co-management were included. The primary outcomes examined were one-year mortality, functional independence (Barthel ADL scores, independent walking), length of hospital stay and postoperative complications (delirium, infections, falls).
Six RCTs with 1,780 patients (894 geriatric care, 886 standard care) were analyzed. Geriatric care was associated with improved ADL scores (Cohen's d = 0.066, 95% CI 0.027-0.105) and a 19% higher rate of independent walking (RR = 1.19, 95% CI 1.092-1.288). The length of hospital stay was reduced by 1.39 days (95% CI - 1.98 to - 0.80). Complication rates decreased slightly (- 3.60%), but no significant reduction in one-year mortality was observed (- 2.26%). Heterogeneity was high for functional outcomes (I = 99.91%) and LOS (I = 99.99%).
Geriatric care improves short-term functional outcomes, reduces complications and shortens hospital stay in elderly patients with hip fractures. However, its impact on one-year mortality is limited. Standardized geriatric care models and further research on long-term recovery strategies are needed to optimize outcomes.
髋部骨折对老年人的发病率和死亡率有重大影响，常导致功能丧失和医疗负担增加。老年共同管理在改善术后结局方面的作用仍存在争议。本荟萃分析评估老年护理对髋部骨折老年患者功能恢复、并发症、住院时间和一年死亡率的影响。
根据PRISMA指南进行荟萃分析。纳入比较标准骨科护理与老年共同管理的随机对照试验（RCT）和前瞻性队列研究。检查的主要结局是一年死亡率、功能独立性（Barthel日常生活活动评分、独立行走）、住院时间和术后并发症（谵妄、感染、跌倒）。
分析了6项RCT，共1780例患者（894例接受老年护理，886例接受标准护理）。老年护理与ADL评分改善相关（Cohen's d = 0.066，95%CI 0.027 - 0.105），独立行走率高19%（RR = 1.19，95%CI 1.092 - 1.288）。住院时间缩短1.39天（95%CI - 1.98至 - 0.80）。并发症发生率略有下降（- 3.60%），但未观察到一年死亡率有显著降低（- 2.26%）。功能结局（I = 99.91%）和住院时间（I = 99.99%）的异质性较高。
老年护理可改善髋部骨折老年患者的短期功能结局，减少并发症并缩短住院时间。然而，其对一年死亡率的影响有限。需要标准化的老年护理模式和对长期康复策略的进一步研究以优化结局。
