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Prognostic significance of frailty in older patients with hip fracture: a systematic review and meta-analysis

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Abstract

Purpose

Hip fracture (HF) has become a major healthcare concern associated with higher mortality in older patients. Frailty is one of the most important problems in aging population but its prognostic value in HF remains susceptible. This systematic review and meta-analysis aimed to evaluate the association between frailty and adverse outcomes in older patients with HF.

Methods

We systematically searched electrical databases including PubMed and Embase to find eligible literature with end-search restriction of February 20, 2021. The main endpoints were all-cause mortality, peri-operative complications, abnormal discharge, and length of stay (LOS). Pooled effect size was calculated by random-effects or fixed-effect model according to study heterogeneity. Three subgroup analyses based on follow-up times, study design, and frailty criteria were conducted.

Results

We screened 22 studies out of 1599 identified studies in our analysis. Compared with normal patients, frail ones had a higher risk of mortality both before (OR = 3.48, 95% CI: 2.50–4.85, I2 = 87.2%, P < 0.001) and after (OR = 1.87, 95% CI: 1.44–2.44, I2 = 85.5%, P < 0.001) adjustment. The incidence of peri-operative complications, abnormal discharge, and prolonged LOS also significantly increased in frail subjects. There was no publication bias observed and the pooled results were stable based on sensitivity analysis.

Conclusion

Overall, more attention needs to be paid to the prognostic effects caused by frailty in seniors with HF. Better understanding of the association between frailty and adverse outcomes in HF could help doctors perform co-management across orthopaedic and geriatric departments.

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Data availability

All data generated or analyzed during this study are included in this published article and supplementary files.

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Funding

Funding was from the National Key R&D Program of China (project 2020YFC2008000); the National Key R&D Program of China (project 2018YFC2002400; subproject 2018YFC2002405); and the Regional Innovation Cooperation Program of Science and Technology Commission Foundation of Sichuan Province (2021YFQ0031).

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  1. Bingzi Yan and Wanting Sun contributed equally to this work.

Authors and Affiliations

  1. West China School of Medicine, Sichuan University, Renmin South Road, No. 17, Wuhou District, Chengdu, 610041, China

    Bingzi Yan & Wanting Sun

  2. Chinese Evidence-Based Medicine Center and CREAT Group, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Centre, Chengdu, Sichuan, China

    Wen Wang

  3. National Clinical Research Center of Geriatrics, Geriatric Medicine Center, West China Hospital, Sichuan University, No. 37, Guoxue Rd, Wuhou District, Chengdu, 610041, China

    Jinhui Wu & Qingyu Dou

  4. Department of Orthopedics, West China School of Medicine, West China Hospital, Sichuan University, No. 37, Wuhou Guoxue Road, Chengdu, 610041, Sichuan, China

    Guanglin Wang

Authors
  1. Bingzi Yan
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  2. Wanting Sun
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  3. Wen Wang
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  4. Jinhui Wu
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  5. Guanglin Wang
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  6. Qingyu Dou
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Contributions

BZY designed this study, screened and selected studies for inclusion, extracted data, performed meta-analyses and drafted the manuscript; WTS performed study selection according to criteria, data extraction, meta-analyses and manuscript writing; WW, JHW and GLW evaluated the methodological quality of the included studies; QYD assisted with the study design, results confirmation and manuscript composition, as well as offered advanced professional information in relevant disciplines. The final manuscript has been read critically and approved by all the authors critically.

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Correspondence to Qingyu Dou.

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Yan, B., Sun, W., Wang, W. et al. Prognostic significance of frailty in older patients with hip fracture: a systematic review and meta-analysis. International Orthopaedics (SICOT) 46, 2939–2952 (2022). https://doi.org/10.1007/s00264-022-05605-9

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