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Prognostic factors of in-hospital complications after hip fracture surgery: a scoping review

Research output: Contribution to journalReview article

Katie Jane Sheehan, Evan Guerrero, David Tainter, Brian Dial, Rhian Milton-Cole, James A. Blair, James Alexander, Priti Swamy, Lisa Kuramoto, Pierre Guy, Janet Bettger, Boris Sobolev

Original languageEnglish
Pages (from-to)1339-1351
Number of pages13
JournalOsteoporosis International
Issue number7
Early online date29 Apr 2019
Publication statusPublished - 1 Jul 2019


King's Authors


To examine prognostic factors that influence complications after hip fracture surgery. To summarise proposed underlying mechanisms for their influence.
We reported according to Preferred Reporting Items for Systematic Review and Meta-Analysis Scoping Review extension. We searched MEDLINE, Embase, CINAHL, AgeLine, Cochrane Library, and reference lists of retrieved studies for studies of prognostic factor/s of postoperative in-hospital medical complication/s among patients 50 years and older treated surgically for non-pathological closed hip fracture, published in English January 2008 - January 2018. We excluded studies of surgery type or in-hospital medications. Screening was duplicated by two independent reviewers. One reviewer completed extraction with accuracy checks by a second. We summarised extent, nature, and proposed underlying mechanisms for prognostic factors of complications narratively and in a dependency graph.
We identified 44 prognostic factors of in-hospital complications after hip fracture surgery from 56 studies. Of these, we identified 7 patient factors– dehydration, anaemia, hypotension, heart rate variability, pressure risk, nutrition, indwelling catheter use; and 7 process factors– time to surgery, anaesthetic type, transfusion strategy, orthopaedic versus geriatric/comanaged care, and multidisciplinary care pathway, potentially modifiable during index hospitalisation. We identified underlying mechanisms for 15 of 44 factors. The reported association between 12 prognostic factors and complications was inconsistent across studies.
Most factors were reported by one study with no proposed underlying mechanism for their influence. Where reported by more than one study, there was inconsistency in reported associations and the conceptualisation of complications differed, limiting comparison across studies. It is therefore not possible to be certain whether intervening on these factors would reduce the rate of complications after hip fracture surgery.

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