Does early surgery improve outcomes for periprosthetic fractures of the hip and knee? A systematic review and meta-analysis.
Does early surgery improve outcomes for periprosthetic fractures of the hip and knee? A systematic review and meta-analysis.
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DOI：
10.1007/s00402-020-03739-2
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发表时间：
2021-08
影响因子：
2.3
通讯作者：
Johnston AT
中科院分区：
文献类型：
--
作者：
Farrow L;Ablett AD;Sargeant HW;Smith TO;Johnston AT
先前的证据已经证实，早期手术有利于改善老年人群中患有先天性髋部骨折的患者的预后。假体周围骨折的患者已被证明与髋部和膝部周围骨折的患者具有相似的人口统计学特征和结果。因此，我们开始通过系统评价和荟萃分析来确定髋部和膝部假体周围骨折的早期手术和延迟手术的围手术期结果是否存在类似差异。对文献检索结果进行筛选，寻找符合纳入标准的研究。早期手术和延迟手术组由研究作者定义。主要结局指标是 30 天死亡率。如果研究具有足够的同质性，则进行随机效应荟萃分析。使用 ROBINS-I 标准评估个体研究的偏倚风险，并使用 GRADE 标准进行独立结果评估。审查方案在开始前已在 PROSPERO 上注册（注册号 CRD42019149360）。 11 项研究符合纳入标准 (n = 3006)。报告研究中从入院到手术的平均时间为 64 小时。根据研究作者的定义，59.6% 的患者接受了早期手术。我们发现，与延迟手术相比，早期手术患者的 30 天死亡率显着降低（RR 0.21；95% CI 0.05，0.90；p = 0.04，n = 2022）。与延迟手术相比，早期手术在医疗并发症、住院时间、输血风险和再次手术方面的结果也明显更好。所有个体结果的证据质量都很低或非常低。有证据表明，对于髋部和膝部假体周围骨折患者，延迟手术会对死亡率和其他重要的患者预后产生有害影响。然而，现有文献存在明显的局限性，需要进一步适当设计的大规模研究来证实这些发现。在线版本包含可在 10.1007/s00402-020-03739-2 获取的补充材料。
Previous evidence has established that early surgery is beneficial to improve outcomes for individuals with native hip fractures in the elderly population. Patients who sustain a periprosthetic fracture have been demonstrated to have similar demographics and outcomes as those with native fractures around the hip and knee. We therefore set out to determine if there is a similar difference in perioperative outcomes between early and delayed surgery for periprosthetic fractures of the hip and knee through a systematic review and meta-analysis. Literature search outputs were screened for studies meeting the inclusion criteria. The groups of early surgery and delayed surgery were defined by study authors. The primary outcome measure was 30 day mortality. Where there was sufficient study homogeneity, a random-effects meta-analysis was performed. Individual study risk of bias was assessed using the ROBINS-I criteria, with the GRADE criteria used for independent outcome evaluation. The review protocol was registered on PROSPERO prior to commencement (Registration number CRD42019149360). The inclusion criteria was met in 11 studies (n = 3006). Mean time to surgery from admission for reporting studies was 64 h. 59.6% patients underwent early surgery as defined by the study authors. We identified a significantly lower risk of 30 day mortality for those with early surgery versus delayed surgery (RR 0.21; 95% CI 0.05, 0.90; p = 0.04, n = 2022). There were also significantly better outcomes for early versus delayed surgery regarding: medical complications, length of stay, transfusion risk, and reoperation. The quality of evidence for all the individual outcomes was low or very low. There is evidence that delaying surgery in those with periprosthetic fractures of the hip and knee has a deleterious impact on mortality and other important patient outcomes. There are, however, notable limitations to the existing available literature, with further appropriately designed large-scale studies required to confirm these findings. The online version contains supplementary material available at 10.1007/s00402-020-03739-2.
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影响因子：
3.7
作者：
Moher D;Shamseer L;Clarke M;Ghersi D;Liberati A;Petticrew M;Shekelle P;Stewart LA;PRISMA-P Group
通讯作者：
PRISMA-P Group
影响因子：
3.5
作者：
Boddapati, Venkat;Grosso, Matthew J.;Shah, Roshan P.
通讯作者：
Shah, Roshan P.
影响因子：
2.3
作者：
Orfanos, Georgios;Lim, Justin;Youssef, Bishoy
通讯作者：
Youssef, Bishoy
DOI：
10.1302/0301-620x.87b3.15300
发表时间：
2005-03-01
影响因子：
--
作者：
Weller, I;Wai, EK;Kreder, HJ
通讯作者：
Kreder, HJ
影响因子：
5.3
作者：
Bhattacharyya, Timothy;Chang, Denis;Malchau, Henrik
通讯作者：
Malchau, Henrik