title: Pre-operative indicators for mortality following hip fracture surgery: a systematic review and meta-analysis.
abstract: OBJECTIVE
  hip fracture is a common and serious condition associated with high mortality. This study aimed to identify pre-operative characteristics which are associated with an increased risk of mortality after hip fracture surgery.
  
  
  METHODS
  systematic search of published and unpublished literature databases, including EMBASE, MEDLINE, AMED, CINAHL, PubMed and the Cochrane Library, was undertaken to identify all clinical studies on pre-operative predictors of mortality after surgery in hip fracture with at least 3-month follow-up. Data pertaining to the study objectives was extracted by two reviewers independently. Where study homogeneity was evidence, a meta-analysis of pooled relative risk and 95% confidence intervals was performed for mortality against pre-admission characteristics.
  
  
  RESULTS
  fifty-three studies including 544,733 participants were included. Thirteen characteristics were identified as possible pre-operative indicators for mortality. Following meta-analysis, the four key characteristics associated with the risk of mortality up to 12 months were abnormal ECG (RR: 2.00; 95% CI: 1.45, 2.76), cognitive impairment (RR: 1.91; 95% CI: 1.35, 2.70), age >85 years (RR: 0.42; 95% CI: 0.20, 0.90) and pre-fracture mobility (RR: 0.13; 95% CI: 0.05, 0.34). Other statistically significant pre-fracture predictors of increased mortality were male gender, being resident in a care institution, intra-capsular fracture type, high ASA grade and high Charlson comorbidity score on admission.
  
  
  CONCLUSIONS
  this review has identified the characteristics of patients with a high risk of mortality after a hip fracture surgery beyond the peri-operative period who may benefit from comprehensive assessment and appropriate management.
  CRD42012002107.
authors.affiliation: Faculty of Medicine and Health Sciences, Queen's Building, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK.
authors.forename: Toby
authors.initials: T
authors.lastname: Smith
authors.affiliation: Care of the Elderly Department, Colchester General Hospital, Turner Road, Colchester, UK.
authors.forename: Kelum
authors.initials: K
authors.lastname: Pelpola
authors.affiliation: Faculty of Medicine and Health Sciences, Queen's Building, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK.
authors.forename: Martin
authors.initials: M
authors.lastname: Ball
authors.affiliation: Department of Medicine for the Elderly, Norfolk and Norwich University, Norwich, UK.
authors.forename: Alice
authors.initials: A
authors.lastname: Ong
authors.affiliation: School of Medicine and Dentistry, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, UK.
authors.forename: Phyo Kyaw
authors.initials: PK
authors.lastname: Myint
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders; D015897:Comorbidity; D004562:Electrocardiography; D005260:Female; D006620:Hip Fractures / Q000401:mortality* / Q000601:surgery*; D006801:Humans; D008297:Male; D019637:Orthopedic Procedures; D011237:Predictive Value of Tests; D057234:Preoperative Period; D012307:Risk Factors; D012737:Sex Factors; D015996:Survival Rate
keywords: elderly; femoral fracture; mortality; older people; prognostic indicators; risk factors; systematic review