Health-related quality-of-life, complications, and mortality rates after geriatric acetabular fracture, non-operative compared to operative management: a systematic review and meta-analysis.

OBJECTIVE

to compare the Health-Related Quality-of-Life (HRQoL) and functional outcomes, complications, and mortality rates between non-operative management (NOM) and operative management (OM) of geriatric acetabular fracture (GAF).

METHODS

This systematic review and meta-analysis were conducted following the PRISMA guidelines. The Medline and Embase databases were searched for eligible articles, initially yielding 274 articles, of which 13 were included in the final analysis.

RESULTS

The 13 studies included 5680 patients; 41.7% had OM, while 58.3% had NOM. The average age of patients was 74.1 years (73.0 for OM and 77.1 for NOM), and 64.9% were males. Of the 2213 OM patients, 90.3% had open reduction and internal fixation (ORIF), 7.4% had closed reduction and percutaneous internal fixation (CRPIF), and 2.6% had acute total hip arthroplasty (THA). The HRQoL outcomes were reported inconsistently from four studies; only two compared OM vs. NOM, and they showed no difference between both management options initially; however, in one study, HRQoL outcomes were significantly better in the OM group after 2 years as assessed using Katz Index of Activities of Daily Living, Lawton and Brody Index of Instrumental Activities of Daily Living, and PARKER Index. A comparison of functional outcomes was reported in four studies; two showed significantly better functional outcomes in the OM group, while the other two studies reported no differences at the last follow-up. Using the NOM as the reference, the odds ratio (OR) for having at least one complication was 2.22 (95% confidence interval (CI): 1.18 to 4.19), indicating a statistically significant increased likelihood of complications with OM (P < 0.05). The incidence of conversion to THA ranged from 10.3% to 28% with OM and from 0% to 15.8% with NOM; the overall pooled estimate showed an OR of 3.81 (95% CI: 2.18 to 6.67), indicating a significantly increased risk of THA conversion after OM (P < 0.05). The overall pooled estimate for 1-year mortality showed an OR of 0.42 (95% CI: 0.26 to 0.68), indicating a significant reduction in 1-year mortality after OM (P < 0.05).

CONCLUSION

The outcomes reported after various GAF management options are not uniform, and there is a deficiency in reporting the HRQoL and functional outcomes when comparing OM vs. NOM, which hinders a solid conclusion regarding the superiority of one management option over the other. However, even though OM carries a higher risk of complications and conversion to THA rates, it is associated with lower mortality for up to 1 year of follow-up.