Impact of diabetes mellitus on risk of major complications after hip fracture: a systematic review and meta-analysis

Abstract

Background The impact of diabetes mellitus (DM) on adverse outcomes in hip fracture patients is unclear. Furthermore, no review has synthesized evidence on this subject. Therefore, the current study was designed to answer the following research question: Does DM increase the risk of mortality and major systemic complications in patients with hip fractures? Methods PubMed, Embase, and Google Scholar were searched from 1st January 2000 to 1st August 2021 for studies comparing DM and non-DM patients with hip fractures. Outcomes of interest were pooled using risk ratios (RR). The study was registered on PROSPERO (CRD42021268525). Results Sixteen studies were included. Meta-analysis revealed a statistically significant increased risk of mortality in diabetics as compared to non-diabetics after 1 year (RR: 1.24 95% CI 1.08, 1.43 I2 = 62% p = 0.003). Pooled analysis of eight studies reporting adjusted mortality outcomes also demonstrated similar results (RR: 1.17 95% CI 1.09, 1.25 I2 = 74% p < 0.0001). We noted a statistically significant increase in the risk of cardiac complications (RR: 1.44 95% CI 1.17, 1.78 I2 = 19% p = 0.0005) and risk of renal failure in diabetics as compared to non-diabetics (RR: 1.32 95% CI 1.04, 1.68 I2 = 0% p = 0.02); but no difference in the risk of cerebrovascular (RR: 1.45 95% CI 0.74, 2.85 I2 = 47% p = 0.28), pulmonary (RR: 0.94 95% CI 0.73, 1.23 I2 = 8% p = 0.67) and thromboembolic complications (RR: 0.81 95% CI 0.56, 1.17 I2 = 28% p = 0.26). Conclusion Our results indicate that diabetics have an increased risk of mortality as compared to non-diabetics. Scarce data indicates that the risk of cardiac complications and renal failure are increased in patients with DM but there is no difference in the risk of cerebrovascular, pulmonary, or thromboembolic complications. Further studies are needed to strengthen the current conclusions.

Clinical Characteristics of Spinal versus General Anaesthesia in Older Patients Undergoing Hip Fracture Repair Surgery in Jordan: A Multicentre Study

“…Finally, in our study, the presence of diabetes mellitus, the use of cemented hip arthroplasty, the occurrence of postoperative DVT/PE, and readmission within one month were all significant predictors for higher mortality after hip fracture repair. A meta-analysis by Shen et al determined a higher risk of mortality among individuals with diabetes mellitus compared to those without after one year [30]. The RR was 1.2, 95%CI = 1.1-1.4.…”

Associations between presence of diabetes, mortality and fracture type in individuals with a hip fracture

“…Although the decreased life expectancy attributed to diabetes attenuates with older age [1], an overlooked aspect of diabetes care in older age is the increased risk of hip fractures, and hip-fracture associated mortality [2,3]. This increased risk is often attributed to falls associated with clinical evidence of end-organ damage, such as retinopathy and neuropathy, and to a higher propensity to fractures due to diabetes-associated bone fragility and sarcopenia [4,5].…”