Comparative assessment of early versus delayed surgery to treat proximal femoral fractures in elderly patients: A systematic review and meta-analysis.

BACKGROUND

Recently, many studies have suggested that timely surgery to treat proximal femoral fractures can benefit patients in many respects. However, both the short- and long-term outcomes, and the perioperative complications, of early surgery remain controversial. In addition, the optimal cut-off time for early surgery remains unclear. Thus, we performed a meta-analysis to compare and evaluate the benefits of early versus delayed surgery in terms of the clinical outcomes of patients with proximal femoral fractures.

METHODS

We searched the Cochrane Library, PubMed, EMBASE, and Web of Science databases to February 1, 2018 and retrieved original studies comparing the efficacy of early versus delayed surgery for proximal femoral fractures. We calculated risk ratios (RRs) and odds ratios (ORs) with 95% confidence intervals (CIs) and compared the outcomes of early and delayed surgery. We performed subgroup analyses to explore mortality and perioperative complications associated with different cut-off times for surgery, for various periods. Two reviewers assessed the quality of the included studies and independently extracted the data. We followed the suggestions of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. All statistical analyses were performed using the standard statistical procedures of Review Manager 5.2.

RESULTS

A total of 27 studies (N = 33,727 participants) were included in the present analysis. Compared to delayed surgery, early surgery significantly reduced mortality and complications. The mortality rates of patients who underwent surgery within 48 and 24 h of fracture were 28 and 23% less than those of patients operated upon after 48 h (RR = 0.72; 95% CI: 0.71-0.73) and 24 h (RR = 0.77; 95% CI: 0.65-0.93). In addition, early surgery was associated with fewer perioperative complications than delayed surgery (OR = 0.52; 95% CI: 0.35-0.76), especially in terms of postoperative pressure ulcers (OR = 0.55; 95% CI: 0.45-0.68), urinary tract infections (OR = 0.57; 95% CI: 0.49-0.67), and thromboembolic events (OR = 0.61; 95% CI: 0.39-0.96).

CONCLUSIONS

Early surgery reduces mortality associated with proximal femoral fractures and the frequency of serious perioperative complications when comparing with delayed surgery.