Key result
Postoperative MACE after hip fracture surgery varies widely from ~0.1% to ~15% across studies.
Why the study?
The incidence of major adverse cardiovascular events following hip fracture surgery in older adults remains unclear due to substantial heterogeneity in existing studies.
Systematic Review (n=1,591,703)
The massive variability in reported postoperative MACE rates (0.08% to 14.89%) highlights extreme definitional inconsistency across studies, underscoring the urgent need for standardized cardiovascular endpoints and frailty assessments in older adults undergoing hip fracture surgery.
Wide MACE incidence variability limits perioperative risk assessment in older adults; leaves open standardized definitions for future observational synthesis.
The reported incidence of major adverse cardiovascular events(MACE) following hip fracture surgery in older adults remains unclear, with existing studies exhibiting substantial heterogeneity. We conducted a systematic review in accordance with PRISMA 2020 guidelines. PubMed, Web of Science, EMBASE, Cochrane Library, and four Chinese databases were searched from inception to September 2025. Retrospective or prospective cohort studies reporting MACE incidence in patients aged ≥ 60 years after hip fracture surgery were eligible. Due to extreme statistical heterogeneity (I 2 > 95%) identified during pre-synthesis, a descriptive synthesis was performed instead of a meta-analysis. Study characteristics and MACE incidence were summarized using descriptive statistics, presented as medians with interquartile ranges (IQR) and overall ranges. Sixteen retrospective cohort studies involving 1,591,703 patients were included. The reported MACE incidence varied widely, from 0.08% to 14.89%. Heart failure showed the highest median incidence among component events (9.55%, IQR 6.73–12.37%); however, this estimate is derived from only four studies with a small total sample ( n = 2,230) and should be interpreted with caution. Stratification by fracture type and surgical method revealed only minor median differences with broad and overlapping ranges, suggesting that anatomical and procedural factors alone do not explain the observed variability. The extensive variability in reported MACE rates underscores definitional inconsistency and patient physiological heterogeneity (e.g. frailty) as fundamental issues. Future research must prioritize standardized MACE definitions. Our findings suggest that patient-centered risk stratification, incorporating frailty assessment, may hold promise for perioperative cardiovascular protection; however, this hypothesis requires formal testing in future prospective studies with standardized MACE definitions.
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Yuan et al. (2026) conducted a systematic review in Hip fracture (n=1,591,703). Hip fracture surgery was evaluated on Incidence of major adverse cardiovascular events (MACE). The reported incidence of MACE after hip fracture surgery in older adults varied widely from 0.08% to 14.89%, highlighting significant definitional inconsistency and patient heterogeneity.
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