Research progress of rapid surgery for hip fracture in elderly patients_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

HAN Chao ¹ , LI Xiaodan ² , SUN Xiang ¹ , HAN Zhe ¹ , LIU Jianan ¹ , HE Weiwei ¹ ,  DONG Qiang ¹

1. Department of Hip Traumatology, Division Ⅱ, Tianjin Hospital, Tianjin University (Tianjin Hospital), Tianjin, 300211, P. R. China;
2. Department of Anesthesiology, Tianjin First Center Hospital, Tianjin, 300192, P. R. China;

Corresponding author：

DONG Qiang, Email: dongqiangtianjin@126.com

Keywords：

Hip fracture; elderly patient; surgery timing; impact factor

DOI：

10.7507/1002-1892.202308038

Video：

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Objective To review the research progress of rapid surgery for hip fracture in elderly patients. Methods The published studies, expert consensus, and guidelines at home and abroad were systematically summarized from the aspects of the characteristics of aging population, the benefits of rapid surgery, the disadvantages of delayed surgery, and the recommendations of current guidelines, so as to further guide clinical practice. Results Hip fracture is a common fracture type in the elderly population. As elderly patients generally have poor physique and often have a variety of underlying diseases, such as hypostatic pneumonia, bedsore, lower limb vein thrombosis, and other complications in conservative treatment, its disability rate and mortality are high, so surgical treatment is the first choice. At present, most relevant studies and expert consensus and guidelines at home and abroad support rapid surgery, that is, preoperative examination should be started immediately after admission, and adverse factors such as taking anticoagulant drugs, serious cardiovascular diseases, and severe anemia should be clearly and actively corrected, and surgery should be completed within 48 hours after admission as far as possible. Rapid surgery can not only significantly reduce the mortality of patients, but also reduce the length of hospital stay and the incidence of perioperative cognitive impairment, which is conducive to the recovery of patients with pain during hospitalization and postoperative function, and improve the prognosis of patients. Conclusion In order to avoid many problems caused by delayed surgery, the elderly patients with hip fracture should be operated as soon as possible under the condition of actively correcting the adverse factors. Comprehensive evaluation and preparation, the development of an individualized surgical plan, and the formation of a multidisciplinary medical team can reduce surgical risks and improve effectiveness.

Citation： HAN Chao, LI Xiaodan, SUN Xiang, HAN Zhe, LIU Jianan, HE Weiwei, DONG Qiang. Research progress of rapid surgery for hip fracture in elderly patients. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(12): 1556-1561. doi: 10.7507/1002-1892.202308038 Copy

1.	Health quality improvement partnership. National hip fracture database annual report 2019 [R/OL]. (2020-01-07) [2023-10-13]. https://ckan.publishing.service.gov.uk/dataset/national-hip-fracture-database-annual-report-2019.
2.	Qi YM, Wang HP, Li YJ, et al. The efficacy and safety of intravenous tranexamic acid in hip fracture surgery: A systematic review and meta-analysis. J Orthop Translat, 2019, 19: 1-11.
3.	Nishimura Y, Inagaki Y, Noda T, et al. Risk factors for mortality after hip fracture surgery in Japan using the National Database of Health Insurance Claims and Specific Health Checkups of Japan. Arch Osteoporos, 2023, 18(1): 91.
4.	中国老年医学学会骨与关节分会创伤骨科学术工作委员会. 老年髋部骨折诊疗专家共识 (2017). 中华创伤骨科杂志, 2017, 19(11): 921-927.
5.	Rapp K, Becker C, Todd C, et al. The association between orthogeriatric co-management and mortality following hip fracture. Dtsch Arztebl Int, 2020, 117(4): 53-59.
6.	Bhandari M, Swiontkowski M. Management of acute hip fracture. N Engl J Med, 2017, 377(21): 2053-2062.
7.	Zhang J, Yang M, Zhang X, et al. The effectiveness of a co-management care model on older hip fracture patients in China—A multicentre non-randomised controlled study. Lancet Reg Health West Pac, 2021, 19: 100348.
8.	Pincus D, Ravi B, Wasserstein D, et al. Association between wait time and 30-day mortality in adults undergoing hip fracture surgery. JAMA, 2017, 318(20): 1994-2003.
9.	Uzoigwe CE, Burnand HG, Cheesman CL, et al. Early and ultra-early surgery in hip fracture patients improves survival. Injury, 2013, 44(6): 726-729.
10.	Moja L, Piatti A, Pecoraro V, et al. Timing matters in hip fracture surgery: patients operated within 48 hours have better outcomes. A meta-analysis and meta-regression of over 190, 000 patients. PLoS One, 2012, 7(10): e46175.
11.	Klestil T, Röder C, Stotter C, et al. Impact of timing of surgery in elderly hip fracture patients: a systematic review and meta-analysis. Sci Rep, 2018, 8(1): 13933.
12.	Vidán MT, Sánchez E, Gracia Y, et al. Causes and effects of surgical delay in patients with hip fracture: a cohort study. Ann Intern Med, 2011, 155(4): 226-233.
13.	Magnéli M, Kelly-Pettersson P, Rogmark C, et al. Timing of adverse events in patients undergoing acute and elective hip arthroplasty surgery: a multicentre cohort study using the Global Trigger Tool. BMJ Open, 2023, 13(6): e064794.
14.	Mitchell SM, Chung AS, Walker JB, et al. Delay in hip fracture surgery prolongs postoperative hospital length of stay but does not adversely affect outcomes at 30 days. J Orthop Trauma, 2018, 32(12): 629-633.
15.	Al-Ani AN, Samuelsson B, Tidermark J, et al. Early operation on patients with a hip fracture improved the ability to return to independent living. A prospective study of 850 patients. J Bone Joint Surg (Am), 2008, 90(7): 1436-1442.
16.	Kristan A, Omahen S, Tosounidis TH, et al. When does hip fracture surgery delay affects the length of hospital stay? Eur J Trauma Emerg Surg, 2022, 48(2): 701-708.
17.	Lefaivre KA, Macadam SA, Davidson DJ, et al. Length of stay, mortality, morbidity and delay to surgery in hip fractures. J Bone Joint Surg (Br), 2009, 91(7): 922-927.
18.	Jaatinen R, Luukkaala T, Hongisto MT, et al. In-hospital delirium as a prognostic factor for new cognitive disorder in a 1-year post-hip fracture follow-up. Dement Geriatr Cogn Disord, 2021, 50(3): 296-302.
19.	Wu J, Yin Y, Jin M, et al. The risk factors for postoperative delirium in adult patients after hip fracture surgery: a systematic review and meta-analysis. Int J Geriatr Psychiatry, 2021, 36(1): 3-14.
20.	Yang Y, Zhao X, Dong T, et al. Risk factors for postoperative delirium following hip fracture repair in elderly patients: a systematic review and meta-analysis. Aging Clin Exp Res, 2017, 29(2): 115-126.
21.	Rai SK, Varma R, Wani SS. Does time of surgery and complication have any correlation in the management of hip fracture in elderly and can early surgery affect the outcome? Eur J Orthop Surg Traumatol, 2018, 28(2): 277-282.
22.	Wennberg P, Möller M, Herlitz J, et al. Fascia iliaca compartment block as a preoperative analgesic in elderly patients with hip fractures-effects on cognition. BMC Geriatr, 2019, 19(1): 252.
23.	Albanese AM, Ramazani N, Greene N, et al. Review of postoperative delirium in geriatric patients after hip fracture treatment. Geriatr Orthop Surg Rehabil, 2022, 13: 21514593211058947. https://doi.org/10.1177/21514593211058947.
24.	Jain R, Koo M, Kreder HJ, et al. Comparison of early and delayed fixation of subcapital hip fractures in patients sixty years of age or less. J Bone Joint Surg (Am), 2002, 84(9): 1605-1612.
25.	Fortina M, Carta S, Crainz E, et al. Management of displaced intracapsular femoral neck fracture in young adult: why complications are still so high? Case report of posttraumatic avascular necrosis in a 30-year-old man and a brief review. J Trauma, 2009, 67(5): E163-E166.
26.	Doruk H, Mas MR, Yildiz C, et al. The effect of the timing of hip fracture surgery on the activity of daily living and mortality in elderly. Arch Gerontol Geriatr, 2004, 39(2): 179-185.
27.	Orosz GM, Magaziner J, Hannan EL, et al. Association of timing of surgery for hip fracture and patient outcomes. JAMA, 2004, 291(14): 1738-1743.
28.	Clinkenbeard K, Bossle K, Pape T, et al. Time to hip fracture surgery and mortality. South Med J, 2023, 116(3): 274-278.
29.	Grimes JP, Gregory PM, Noveck H, et al. The effects of time-to-surgery on mortality and morbidity in patients following hip fracture. Am J Med, 2002, 112(9): 702-709.
30.	Harris AHS, Trickey AW, Eddington HS, et al. A tool to estimate risk of 30-day mortality and complications after hip fracture surgery: accurate enough for some but not all purposes? A study from the ACS-NSQIP database. Clin Orthop Relat Res, 2022, 480(12): 2335-2346.
31.	Shin WC, Woo SH, Lee SJ, et al. Preoperative prevalence of and risk factors for venous thromboembolism in patients with a hip fracture: an indirect multidetector ct venography study. J Bone Joint Surg (Am), 2016, 98(24): 2089-2095.
32.	Wenk M, Frey S. Elderly hip fracture patients: surgical timing and factors to consider. Curr Opin Anaesthesiol, 2021, 34(1): 33-39.
33.	Anazor F, Kulkarni A, Barnard K, et al. Timing and safety of hip fracture surgery in patients on direct-acting oral anticoagulants. J Clin Orthop Trauma, 2022, 36: 102080.
34.	Goh EL, Chidambaram S, Rai S, et al. Timing of surgery for hip fracture in patients on direct oral anti-coagulants: a population-based cohort study. Geriatr Orthop Surg Rehabil, 2022, 13: 21514593221088405. doi: 10.1177/21514593221088405.
35.	Tarrant SM, Kim RG, McGregor KL, et al. Dual antiplatelet therapy and surgical timing in geriatric hip fracture. J Orthop Trauma, 2020, 34(10): 559-565.
36.	Thaler HW, Frisee F, Korninger C. Platelet aggregation inhibitors, platelet function testing, and blood loss in hip fracture surgery. J Trauma, 2010, 69(5): 1217-1220.
37.	Hossain FS, Rambani R, Ribee H, et al. Is discontinuation of clopidogrel necessary for intracapsular hip fracture surgery? Analysis of 102 hemiarthroplasties. J Orthop Traumatol, 2013, 14(3): 171-177.
38.	Bateman L, Vuppala S, Porada P, et al. Medical management in the acute hip fracture patient: a comprehensive review for the internist. Ochsner J, 2012, 12(2): 101-110.
39.	McLaughlin MA, Orosz GM, Magaziner J, et al. Preoperative status and risk of complications in patients with hip fracture. J Gen Intern Med, 2006, 21(3): 219-225.
40.	Yonai Y, Ben Natan M, Shadmi N, et al. Reasons for surgical delay in patients with hip fracture. J Healthc Qual, 2022, 44(6): 341-346.
41.	Michel JP, Klopfenstein C, Hoffmeyer P, et al. Hip fracture surgery: is the pre-operative American Society of Anesthesiologists (ASA) score a predictor of functional outcome? Aging Clin Exp Res, 2002, 14(5): 389-394.
42.	Association of Anaesthetists of Great Britain and Ireland. Management of proximal femoral fractures 2011: Association of Anaesthetists of Great Britain and Ireland. Anaesthesia, 2012, 67(1): 85-98.
43.	Su S, Zhang Y, Wang R, et al. Early surgery within 48 h was associated with reduced perioperative blood loss and red blood cell transfusion requirements in older patients with hip fracture: a retrospective study. Eur Geriatr Med, 2023. doi: 10.1007/s41999-023-00834-6.
44.	Cho MR, Cho YJ, Song SK. Factors affecting the need of postoperative blood transfusion in elderly patients with intertrochanteric hip fracture. Sci Prog, 2022, 105(4): 368504221134429.
45.	中华人民共和国国家卫生健康委员会医政司. 老年髋部骨折诊疗与管理指南(2022年版). 骨科临床与研究杂志, 2023, 8(2): 77-83.
46.	Chesser TJS, Inman D, Johansen A, et al. Hip fracture systems-European experience. OTA Int, 2020, 3(1): e050.
47.	American Academy of Orthopaedic Surgeons (AAOS). Management of hip fractures in the elderly: timing of surgical intervention performance measure technical report. 2020 [R/OL]. [2023-10-24]. http://qa.aaos.org/globalassets/quality-and-practice-resources/hip-fractures-in-the-elderly/hip-fx-timing-measure-technical-report.pdf.
48.	Lewis PM, Waddell JP. When is the ideal time to operate on a patient with a fracture of the hip?: a review of the available literature. Bone Joint J, 2016, 98-B(12): 1573-1581.
49.	Scottish Hip Fracture Audit (SHFA). Scottish standards of care for hip fracture patients. National Services Scotland, 2020 [R/OL]. [2023-10-24]. https://www.shfa.scot.nhs.uk/.

1. Health quality improvement partnership. National hip fracture database annual report 2019 [R/OL]. (2020-01-07) [2023-10-13]. https://ckan.publishing.service.gov.uk/dataset/national-hip-fracture-database-annual-report-2019.
2. Qi YM, Wang HP, Li YJ, et al. The efficacy and safety of intravenous tranexamic acid in hip fracture surgery: A systematic review and meta-analysis. J Orthop Translat, 2019, 19: 1-11.
3. Nishimura Y, Inagaki Y, Noda T, et al. Risk factors for mortality after hip fracture surgery in Japan using the National Database of Health Insurance Claims and Specific Health Checkups of Japan. Arch Osteoporos, 2023, 18(1): 91.
4. 中国老年医学学会骨与关节分会创伤骨科学术工作委员会. 老年髋部骨折诊疗专家共识 (2017). 中华创伤骨科杂志, 2017, 19(11): 921-927.
5. Rapp K, Becker C, Todd C, et al. The association between orthogeriatric co-management and mortality following hip fracture. Dtsch Arztebl Int, 2020, 117(4): 53-59.
6. Bhandari M, Swiontkowski M. Management of acute hip fracture. N Engl J Med, 2017, 377(21): 2053-2062.
7. Zhang J, Yang M, Zhang X, et al. The effectiveness of a co-management care model on older hip fracture patients in China—A multicentre non-randomised controlled study. Lancet Reg Health West Pac, 2021, 19: 100348.
8. Pincus D, Ravi B, Wasserstein D, et al. Association between wait time and 30-day mortality in adults undergoing hip fracture surgery. JAMA, 2017, 318(20): 1994-2003.
9. Uzoigwe CE, Burnand HG, Cheesman CL, et al. Early and ultra-early surgery in hip fracture patients improves survival. Injury, 2013, 44(6): 726-729.
10. Moja L, Piatti A, Pecoraro V, et al. Timing matters in hip fracture surgery: patients operated within 48 hours have better outcomes. A meta-analysis and meta-regression of over 190, 000 patients. PLoS One, 2012, 7(10): e46175.
11. Klestil T, Röder C, Stotter C, et al. Impact of timing of surgery in elderly hip fracture patients: a systematic review and meta-analysis. Sci Rep, 2018, 8(1): 13933.
12. Vidán MT, Sánchez E, Gracia Y, et al. Causes and effects of surgical delay in patients with hip fracture: a cohort study. Ann Intern Med, 2011, 155(4): 226-233.
13. Magnéli M, Kelly-Pettersson P, Rogmark C, et al. Timing of adverse events in patients undergoing acute and elective hip arthroplasty surgery: a multicentre cohort study using the Global Trigger Tool. BMJ Open, 2023, 13(6): e064794.
14. Mitchell SM, Chung AS, Walker JB, et al. Delay in hip fracture surgery prolongs postoperative hospital length of stay but does not adversely affect outcomes at 30 days. J Orthop Trauma, 2018, 32(12): 629-633.
15. Al-Ani AN, Samuelsson B, Tidermark J, et al. Early operation on patients with a hip fracture improved the ability to return to independent living. A prospective study of 850 patients. J Bone Joint Surg (Am), 2008, 90(7): 1436-1442.
16. Kristan A, Omahen S, Tosounidis TH, et al. When does hip fracture surgery delay affects the length of hospital stay? Eur J Trauma Emerg Surg, 2022, 48(2): 701-708.
17. Lefaivre KA, Macadam SA, Davidson DJ, et al. Length of stay, mortality, morbidity and delay to surgery in hip fractures. J Bone Joint Surg (Br), 2009, 91(7): 922-927.
18. Jaatinen R, Luukkaala T, Hongisto MT, et al. In-hospital delirium as a prognostic factor for new cognitive disorder in a 1-year post-hip fracture follow-up. Dement Geriatr Cogn Disord, 2021, 50(3): 296-302.
19. Wu J, Yin Y, Jin M, et al. The risk factors for postoperative delirium in adult patients after hip fracture surgery: a systematic review and meta-analysis. Int J Geriatr Psychiatry, 2021, 36(1): 3-14.
20. Yang Y, Zhao X, Dong T, et al. Risk factors for postoperative delirium following hip fracture repair in elderly patients: a systematic review and meta-analysis. Aging Clin Exp Res, 2017, 29(2): 115-126.
21. Rai SK, Varma R, Wani SS. Does time of surgery and complication have any correlation in the management of hip fracture in elderly and can early surgery affect the outcome? Eur J Orthop Surg Traumatol, 2018, 28(2): 277-282.
22. Wennberg P, Möller M, Herlitz J, et al. Fascia iliaca compartment block as a preoperative analgesic in elderly patients with hip fractures-effects on cognition. BMC Geriatr, 2019, 19(1): 252.
23. Albanese AM, Ramazani N, Greene N, et al. Review of postoperative delirium in geriatric patients after hip fracture treatment. Geriatr Orthop Surg Rehabil, 2022, 13: 21514593211058947. https://doi.org/10.1177/21514593211058947.
24. Jain R, Koo M, Kreder HJ, et al. Comparison of early and delayed fixation of subcapital hip fractures in patients sixty years of age or less. J Bone Joint Surg (Am), 2002, 84(9): 1605-1612.
25. Fortina M, Carta S, Crainz E, et al. Management of displaced intracapsular femoral neck fracture in young adult: why complications are still so high? Case report of posttraumatic avascular necrosis in a 30-year-old man and a brief review. J Trauma, 2009, 67(5): E163-E166.
26. Doruk H, Mas MR, Yildiz C, et al. The effect of the timing of hip fracture surgery on the activity of daily living and mortality in elderly. Arch Gerontol Geriatr, 2004, 39(2): 179-185.
27. Orosz GM, Magaziner J, Hannan EL, et al. Association of timing of surgery for hip fracture and patient outcomes. JAMA, 2004, 291(14): 1738-1743.
28. Clinkenbeard K, Bossle K, Pape T, et al. Time to hip fracture surgery and mortality. South Med J, 2023, 116(3): 274-278.
29. Grimes JP, Gregory PM, Noveck H, et al. The effects of time-to-surgery on mortality and morbidity in patients following hip fracture. Am J Med, 2002, 112(9): 702-709.
30. Harris AHS, Trickey AW, Eddington HS, et al. A tool to estimate risk of 30-day mortality and complications after hip fracture surgery: accurate enough for some but not all purposes? A study from the ACS-NSQIP database. Clin Orthop Relat Res, 2022, 480(12): 2335-2346.
31. Shin WC, Woo SH, Lee SJ, et al. Preoperative prevalence of and risk factors for venous thromboembolism in patients with a hip fracture: an indirect multidetector ct venography study. J Bone Joint Surg (Am), 2016, 98(24): 2089-2095.
32. Wenk M, Frey S. Elderly hip fracture patients: surgical timing and factors to consider. Curr Opin Anaesthesiol, 2021, 34(1): 33-39.
33. Anazor F, Kulkarni A, Barnard K, et al. Timing and safety of hip fracture surgery in patients on direct-acting oral anticoagulants. J Clin Orthop Trauma, 2022, 36: 102080.
34. Goh EL, Chidambaram S, Rai S, et al. Timing of surgery for hip fracture in patients on direct oral anti-coagulants: a population-based cohort study. Geriatr Orthop Surg Rehabil, 2022, 13: 21514593221088405. doi: 10.1177/21514593221088405.
35. Tarrant SM, Kim RG, McGregor KL, et al. Dual antiplatelet therapy and surgical timing in geriatric hip fracture. J Orthop Trauma, 2020, 34(10): 559-565.
36. Thaler HW, Frisee F, Korninger C. Platelet aggregation inhibitors, platelet function testing, and blood loss in hip fracture surgery. J Trauma, 2010, 69(5): 1217-1220.
37. Hossain FS, Rambani R, Ribee H, et al. Is discontinuation of clopidogrel necessary for intracapsular hip fracture surgery? Analysis of 102 hemiarthroplasties. J Orthop Traumatol, 2013, 14(3): 171-177.
38. Bateman L, Vuppala S, Porada P, et al. Medical management in the acute hip fracture patient: a comprehensive review for the internist. Ochsner J, 2012, 12(2): 101-110.
39. McLaughlin MA, Orosz GM, Magaziner J, et al. Preoperative status and risk of complications in patients with hip fracture. J Gen Intern Med, 2006, 21(3): 219-225.
40. Yonai Y, Ben Natan M, Shadmi N, et al. Reasons for surgical delay in patients with hip fracture. J Healthc Qual, 2022, 44(6): 341-346.
41. Michel JP, Klopfenstein C, Hoffmeyer P, et al. Hip fracture surgery: is the pre-operative American Society of Anesthesiologists (ASA) score a predictor of functional outcome? Aging Clin Exp Res, 2002, 14(5): 389-394.
42. Association of Anaesthetists of Great Britain and Ireland. Management of proximal femoral fractures 2011: Association of Anaesthetists of Great Britain and Ireland. Anaesthesia, 2012, 67(1): 85-98.
43. Su S, Zhang Y, Wang R, et al. Early surgery within 48 h was associated with reduced perioperative blood loss and red blood cell transfusion requirements in older patients with hip fracture: a retrospective study. Eur Geriatr Med, 2023. doi: 10.1007/s41999-023-00834-6.
44. Cho MR, Cho YJ, Song SK. Factors affecting the need of postoperative blood transfusion in elderly patients with intertrochanteric hip fracture. Sci Prog, 2022, 105(4): 368504221134429.
45. 中华人民共和国国家卫生健康委员会医政司. 老年髋部骨折诊疗与管理指南(2022年版). 骨科临床与研究杂志, 2023, 8(2): 77-83.
46. Chesser TJS, Inman D, Johansen A, et al. Hip fracture systems-European experience. OTA Int, 2020, 3(1): e050.
47. American Academy of Orthopaedic Surgeons (AAOS). Management of hip fractures in the elderly: timing of surgical intervention performance measure technical report. 2020 [R/OL]. [2023-10-24]. http://qa.aaos.org/globalassets/quality-and-practice-resources/hip-fractures-in-the-elderly/hip-fx-timing-measure-technical-report.pdf.
48. Lewis PM, Waddell JP. When is the ideal time to operate on a patient with a fracture of the hip?: a review of the available literature. Bone Joint J, 2016, 98-B(12): 1573-1581.
49. Scottish Hip Fracture Audit (SHFA). Scottish standards of care for hip fracture patients. National Services Scotland, 2020 [R/OL]. [2023-10-24]. https://www.shfa.scot.nhs.uk/.

Chinese Journal of Reparative and Reconstructive Surgery

Research progress of rapid surgery for hip fracture in elderly patients

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