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Prognostic factors of in-hospital complications after hip fracture surgery: a scoping review

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Abstract

Introduction: To examine prognostic factors that influence complications after hip fracture surgery. To summarize proposed underlying mechanisms for their influence. Methods: 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. Results: 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. Conclusions: 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.

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Authors and Affiliations

  1. Department of Population Health Sciences, School of Population Health and Environmental Sciences, King’s College London, London, UK

    K.J. Sheehan, R. Milton-Cole & P. Swamy

  2. Department of Orthopaedic Surgery, Duke University Medical Centre, Durham, NC, USA

    E.M. Guerrero, D. Tainter, B. Dial & J.P. Bettger

  3. Department of Orthopaedics and Rehabilitation, William Beaumont Army Medical Center, El Paso, TX, USA

    J.A. Blair

  4. Department of Rehabilitation Sciences, Kingston & St George’s University of London, London, UK

    J. Alexander

  5. Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, Canada

    L. Kuramoto

  6. Centre for Hip Health and Mobility, University of British Columbia, Vancouver, Canada

    P. Guy

  7. School of Population and Public Health, University of British Columbia, Vancouver, Canada

    B. Sobolev

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  1. K.J. Sheehan
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Correspondence to K.J. Sheehan.

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Conflict of interest

Boris Sobolev and Pierre Guy report receiving grants from the Canadian Institutes of Health Research related to this work. Pierre Guy reports receiving grants from the Natural Sciences and Engineering Research Council of Canada, the Canadian Foundation for Innovation, and the British Columbia Specialists Services Committee for work regarding hip fracture care, outside the submitted work. He has also received fees from the BC Specialists Services Committee (for a provincial quality improvement project on redesign of hip fracture care) and from Stryker Orthopaedics (as a product development consultant), outside the submitted work. He is a board member and shareholder in Traumis Surgical Systems Inc. and a board member for the Canadian Orthopaedic Foundation. He also serves on the speakers’ bureaus of AOTrauma North America and Stryker Canada. Katie Jane Sheehan received funding from the National Institute for Health Research (NIHR) outside of the submitted work. Evan Guerrero, David Tainter, Brian Dial, Rhian Milton-Cole, James A Blair, James Alexander, Priti Swamy, Lisa Kuramoto, and Janet Pruv Bettger have no conflicts of interest to declare.

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Sheehan, K., Guerrero, E., Tainter, D. et al. Prognostic factors of in-hospital complications after hip fracture surgery: a scoping review. Osteoporos Int 30, 1339–1351 (2019). https://doi.org/10.1007/s00198-019-04976-x

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