Key result
Accelerated care for patients with hip fractures did not significantly reduce mortality compared to standard care (RR 0.94), but significantly lowered the risk of delirium and infection and shortened hospital stay.
Why the study?
The study was conducted to assess the impact of time to surgery on mortality, peri-operative complications, and length of stay after a hip fracture using level one evidence.
Does accelerated care/early surgery reduce mortality, peri-operative complications, and length of stay in patients with hip fractures?
Meta-Analysis (n=3,430)
Does accelerated care/early surgery reduce mortality, peri-operative complications, and length of stay in patients with hip fractures?
Accelerated care for hip fractures reduces delirium, infection, and hospital length of stay, though its impact on mortality remains unclear.
Supports early surgery protocols in hip fracture care to lower delirium, infections, and hospital stay; confirms RCT evidence for improved outcomes.
Objectives: The aim of this systematic review was to assess the impact of time to surgery on patient mortality, peri-operative complication rates and length of stay following a hip fracture using level one data. Data Sources: Multiple databases (PubMed, Embase, Medline (Ovid), and Cochrane Library) were searched using terms for "hip fracture" and the intervention "early surgery". Results were filtered to only included randomised controlled trials in the English language published from the year 2000. Study Selection: All results were imported into Covidence and screened by two separate reviewers with conflicts resolved by a third reviewer. Studies were included if they reported data on the relationship between time to theatre and at least one of the outcome measures (mortality, peri-operative complications, and length of stay in hospital). Three papers were finalised to include in this review. Data Extraction: Once selected, each paper had a bias assessment completed by two separate reviewers using the Cochrane RoB2 tool. Any conflicts were resolved by a third reviewer. Data Synthesis: Data from each paper were inputted into RevMan5 for analysis. Approximated sample mean and standard deviation were collected from each paper and included for analysis. RevMan5 was then used to generate forest plots and report data on relative risk and mean difference. Conclusions: This review has shown that accelerated care of patients with hip fractures was associated with lower risks of delirium and infection, and a shorter length of hospital stay. However, the effect of time to surgery on patient mortality is not clear, as the standard care group had a lower mortality than expected for the population at risk and had surgery on average within 24-h of presentation.
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Shah et al. (2023) conducted a meta-analysis in Hip fracture (n=3,430). Accelerated care vs. Standard care was evaluated on Mortality (RR 0.94, 95% CI 0.78-1.14, p=0.55). Accelerated care for patients with hip fractures did not significantly reduce mortality compared to standard care (RR 0.94), but significantly lowered the risk of delirium and infection and shortened hospital stay.
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