Prognosis of nonoperative treatment in elderly patients with a hip fracture: A systematic review and meta-analysis

Loggers, Sverre A. I.; Lieshout, Esther M.M. Van; Joosse, Pieter; Verhofstad, Michael H.J.; Willems, Hanna C.

doi:10.1016/j.injury.2020.08.027

Cited by 58 publications

(50 citation statements)

References 28 publications

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“…We found a very high 30-day mortality of 87% in nonoperatively managed hip fracture patients. These findings differ from other previously published studies with a 30-day mortality ranging from 5% to 65% (Chlebeck et al 2019 , Loggers et al 2020 ). A recent review has already pointed out that these large differences in mortality rates are most probably caused by differences in patient characteristics such as pre-fracture mobility, prevalence of dementia, and living situation (Loggers et al 2020 ).…”

Section: Discussioncontrasting

confidence: 99%

“…These findings differ from other previously published studies with a 30-day mortality ranging from 5% to 65% (Chlebeck et al 2019 , Loggers et al 2020 ). A recent review has already pointed out that these large differences in mortality rates are most probably caused by differences in patient characteristics such as pre-fracture mobility, prevalence of dementia, and living situation (Loggers et al 2020 ). The clinical dilemma whether to decide for NOM and subsequent palliative care mainly applies to very frail elderly hip fracture patients.…”

Section: Discussioncontrasting

confidence: 99%

“…The literature on life expectancy after nonoperative management (NOM) is limited. For example, 30-day and 1-year mortality rates after NOM ranging from 5–65% and 30–95% have been reported (Loggers et al 2020 ). These wide ranges of early mortality rates reflect differences in patient characteristics and fracture types between studies and extrapolation of information from these studies towards shared decision-making in clinical practice is difficult.…”

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confidence: 99%

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Nonoperative management of hip fractures in very frail elderly patients may lead to a predictable short survival as part of advance care planning

et al. 2021

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Section: Discussioncontrasting

confidence: 99%

Section: Discussioncontrasting

confidence: 99%

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Nonoperative management of hip fractures in very frail elderly patients may lead to a predictable short survival as part of advance care planning

et al. 2021

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“…Whether surgical or conservative management is more suitable is still controversial. Although nonoperative management is optional [ 17 ], nonoperative management of frail elderly patients with a hip fracture is associated with a poor prognosis [ 18 ]. In general, conservative treatment is often selected for patients with a severe general condition that makes surgery impossible, resulting in a high mortality rate [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

“…Although nonoperative management is optional [ 17 ], nonoperative management of frail elderly patients with a hip fracture is associated with a poor prognosis [ 18 ]. In general, conservative treatment is often selected for patients with a severe general condition that makes surgery impossible, resulting in a high mortality rate [ 18 ]. In hip fracture with COVID-19 patients reported from Europe, conservative management is selected only in patients who cannot tolerate the operation [ 6 , 19 ].…”

Section: Discussionmentioning

confidence: 99%

Surgical management for hip fracture in a COVID-19 patient: A case report and literature review

Takahara¹,

Furukawa²,

Uefuji³

et al. 2023

Journal of Orthopaedic Science

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Evaluation of Quality of Life After Nonoperative or Operative Management of Proximal Femoral Fractures in Frail Institutionalized Patients

et al. 2022

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IMPORTANCE Decision-making on management of proximal femoral fractures in frail patients with limited life expectancy is challenging, but surgical overtreatment needs to be prevented. Current literature provides limited insight into the true outcomes of nonoperative management and operative management in this patient population.OBJECTIVE To investigate the outcomes of nonoperative management vs operative management of proximal femoral fractures in institutionalized frail older patients with limited life expectancy. DESIGN, SETTING, AND PARTICIPANTSThis multicenter cohort study was conducted between September 1, 2018, and April 25, 2020, with a 6-month follow-up period at 25 hospitals across the Netherlands. Eligible patients were aged 70 years or older, frail, and institutionalized and sustained a femoral neck or pertrochanteric fracture. The term frail implied at least 1 of the following characteristics was present: malnutrition (body mass index [calculated as weight in kilograms divided by height in meters squared] <18.5) or cachexia, severe comorbidities (American Society of Anesthesiologists physical status class of IV or V), or severe mobility issues (Functional Ambulation Category Յ2).EXPOSURES Shared decision-making (SDM) followed by nonoperative or operative fracture management. MAIN OUTCOMES AND MEASURESThe primary outcome was the EuroQol 5 Dimension 5 Level (EQ-5D) utility score by proxies and caregivers. Secondary outcome measures were QUALIDEM (a dementia-specific quality-of-life instrument for persons with dementia in residential settings) scores, pain level (assessed by the Pain Assessment Checklist for Seniors With Limited Ability to Communicate), adverse events (Clavien-Dindo classification), mortality, treatment satisfaction (numeric rating scale), and quality of dying (Quality of Dying and Death Questionnaire). RESULTSOf the 172 enrolled patients with proximal femoral fractures (median [25th and 75th percentile] age, 88 [85-92] years; 135 women [78%]), 88 opted for nonoperative management and 84 opted for operative management. The EQ-5D utility scores by proxies and caregivers in the nonoperative management group remained within the set 0.15 noninferiority limit of the operative management group (

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Prognosis of nonoperative treatment in elderly patients with a hip fracture: A systematic review and meta-analysis

Cited by 58 publications

References 28 publications

Nonoperative management of hip fractures in very frail elderly patients may lead to a predictable short survival as part of advance care planning

Nonoperative management of hip fractures in very frail elderly patients may lead to a predictable short survival as part of advance care planning

Surgical management for hip fracture in a COVID-19 patient: A case report and literature review

Evaluation of Quality of Life After Nonoperative or Operative Management of Proximal Femoral Fractures in Frail Institutionalized Patients

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