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The impact of frailty evaluation on the risk of venous thromboembolism in patients with hip fracture following surgery: a meta-analysis

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Abstract

Background

Frailty has been associated with a higher incidence of overall postoperative complications and mortality. However, the influence of frailty on the risk of venous thromboembolism (VTE) in patients with hip fracture following surgery remains unclear. We performed a meta-analysis to systematically evaluate the above association.

Methods

PubMed, Embase, Cochrane Library, Wanfang and CNKI were searched for relevant observational studies comparing the incidence of postoperative VTE in patients of hip fracture with and without frailty. Data collection, literature searching, and statistical analysis were conducted independently by two authors. Using a heterogeneity-incorporating random-effects model, the results were pooled.

Results

In this meta-analysis, 9509 patients from nine cohort studies were included. Pooled results showed that compared to those without frailty, patients with frailty at admission had a higher incidence of postoperative VTE (odds ratio [OR]: 2.59, 95% confidence interval [CI]: 1.25–5.39, p = 0.01; I2 = 66%). Subgroup analysis suggested the association between frailty and postoperative VTE was more remarkable in studies of patients with frailty prevalence < 50% (OR 6.28, 95% CI 3.31–11.90, p < 0.001; I2 = 8%) as compared to those ≥ 50% (OR 1.30, 95% CI 0.80–2.11, p = 0.28; I2 = 0%; p for subgroup difference < 0.001). Further meta-analyses showed that frailty at baseline was associated with a higher incidence of deep venous thrombosis (OR 3.15, 95% CI 1.33–7.47, p = 0.009; I2 = 59%), but not pulmonary embolism (OR 1.13, 95% CI 0.59–2.16, p = 0.72; I2 = 0%).

Conclusion

Frailty is associated with a higher incidence of postoperative VTE in patients with hip fracture.

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Data availability

All data generated or analyzed during this study are included in this published article.

References

  1. Williamson S, Landeiro F, McConnell T et al (2017) Costs of fragility hip fractures globally: a systematic review and meta-regression analysis. Osteoporos Int 28:2791–2800. https://doi.org/10.1007/s00198-017-4153-6

    Article  CAS  PubMed  Google Scholar 

  2. Griffiths R, Babu S, Dixon P et al (2021) Guideline for the management of hip fractures 2020: guideline by the Association of Anaesthetists. Anaesthesia 76:225–237. https://doi.org/10.1111/anae.15291

    Article  CAS  PubMed  Google Scholar 

  3. Veronese N, Maggi S (2018) Epidemiology and social costs of hip fracture. Injury 49:1458–1460

    Article  PubMed  Google Scholar 

  4. Bhandari M, Swiontkowski M (2017) Management of acute hip fracture. N Engl J Med 377:2053–2062. https://doi.org/10.1056/NEJMcp1611090

    Article  PubMed  Google Scholar 

  5. Sheehan KJ, Guerrero EM, Tainter D et al (2019) Prognostic factors of in-hospital complications after hip fracture surgery: a scoping review. Osteoporos Int 30:1339–1351. https://doi.org/10.1007/s00198-019-04976-x

    Article  CAS  PubMed  Google Scholar 

  6. Segon YS, Summey RD, Slawski B et al (2020) Surgical venous thromboembolism prophylaxis: clinical practice update. Hosp Pract (1995) 48:248–257. https://doi.org/10.1080/21548331.2020.1788893

    Article  PubMed  Google Scholar 

  7. MacDonald DRW, Neilly D, Schneider PS et al (2020) Venous thromboembolism in hip fracture patients: a subanalysis of the FAITH and HEALTH Trials. J Orthop Trauma 34:S70–S75. https://doi.org/10.1097/BOT.0000000000001939

    Article  PubMed  Google Scholar 

  8. Beauchamp-Chalifour P, Belzile EL, Michael R et al (2022) The risk of venous thromboembolism in surgically treated hip fracture: a retrospective cohort study of 5184 patients. Orthop Traumatol Surg Res 108:103142

    Article  PubMed  Google Scholar 

  9. Ngarmukos S, Kim KI, Wongsak S et al (2021) Asia-Pacific venous thromboembolism consensus in knee and hip arthroplasty and hip fracture surgery: Part 1. Diagnosis and risk factors. Knee Surg Relat Res 33:18. https://doi.org/10.1186/s43019-021-00099-y

    Article  PubMed  PubMed Central  Google Scholar 

  10. Mamtora PH, Fortier MA, Barnett SR et al (2020) Peri-operative management of frailty in the orthopedic patient. J Orthop 22:304–307. https://doi.org/10.1016/j.jor.2020.05.024

    Article  PubMed  PubMed Central  Google Scholar 

  11. Hoogendijk EO, Afilalo J, Ensrud KE et al (2019) Frailty: implications for clinical practice and public health. Lancet 394:1365–1375. https://doi.org/10.1016/S0140-6736(19)31786-6

    Article  PubMed  Google Scholar 

  12. Inoue T, Maeda K, Nagano A et al (2020) Undernutrition, sarcopenia, and frailty in fragility hip fracture: advanced strategies for improving clinical outcomes. Nutrients. https://doi.org/10.3390/nu12123743

    Article  PubMed  PubMed Central  Google Scholar 

  13. Yan B, Sun W, Wang W et al (2022) Prognostic significance of frailty in older patients with hip fracture: a systematic review and meta-analysis. Int Orthop 46:2939–2952. https://doi.org/10.1007/s00264-022-05605-9

    Article  PubMed  Google Scholar 

  14. Ma Y, Wang A, Lou Y et al (2022) Effects of frailty on outcomes following surgery among patients with hip fractures: a systematic review and meta-analysis. Front Med (Lausanne) 9:829762. https://doi.org/10.3389/fmed.2022.829762

    Article  PubMed  Google Scholar 

  15. Page MJ, Moher D, Bossuyt PM et al (2021) PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. BMJ 372:n160. https://doi.org/10.1136/bmj.n160

    Article  PubMed  PubMed Central  Google Scholar 

  16. Page MJ, McKenzie JE, Bossuyt PM et al (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 372:n71. https://doi.org/10.1136/bmj.n71

    Article  PubMed  PubMed Central  Google Scholar 

  17. Higgins J, Thomas J, Chandler J et al (2021) Cochrane Handbook for Systematic Reviews of Interventions version 6.2. The Cochrane Collaboration. www.training.cochrane.org/handbook

  18. Wells GA, Shea B, O'Connell D et al (2010) The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp

  19. Higgins JP, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21:1539–1558. https://doi.org/10.1002/sim.1186

    Article  PubMed  Google Scholar 

  20. Patsopoulos NA, Evangelou E, Ioannidis JP (2008) Sensitivity of between-study heterogeneity in meta-analysis: proposed metrics and empirical evaluation. Int J Epidemiol 37:1148–1157. https://doi.org/10.1093/ije/dyn065

    Article  PubMed  PubMed Central  Google Scholar 

  21. Egger M, Davey Smith G, Schneider M et al (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315:629–634

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Kua J, Ramason R, Rajamoney G et al (2016) Which frailty measure is a good predictor of early post-operative complications in elderly hip fracture patients? Arch Orthop Trauma Surg 136:639–647. https://doi.org/10.1007/s00402-016-2435-7

    Article  PubMed  Google Scholar 

  23. Chan S, Wong EKC, Ward SE et al (2019) The predictive value of the clinical frailty scale on discharge destination and complications in older hip fracture patients. J Orthop Trauma 33:497–502. https://doi.org/10.1097/BOT.0000000000001518

    Article  PubMed  Google Scholar 

  24. You L, Wu KQ (2020) Effect of Frality on perioperative risk and prognosis in elderly patients with hip fracture. J Nanchang Univ 8:95

    Google Scholar 

  25. Zhu SQ, Xing YH, Zhang L et al (2020) Predictive value of Frail Scale and CHS index on postoperative outcomes in elderly patients with hip fracture. J Clin Anesthesiol 36:962–965. https://doi.org/10.12089/jca.2020.10.006

    Article  Google Scholar 

  26. Sang WA, Durrani H, Liu H et al (2021) Frailty score as a predictor of outcomes in geriatric patients with isolated hip fractures. Am Surg. https://doi.org/10.1177/00031348211058629

    Article  PubMed  Google Scholar 

  27. Chen ZF, Yu XH, Zhao B (2022) Risk factor of postoperative lower exemity deep venous thrombosis in geriatric hip fracture patients. J Clin Emerg 23:237–241. https://doi.org/10.13201/j.issn.1009-5918.2022.04.003

    Article  Google Scholar 

  28. Hao XY, Ouyang CL, Xu ZY et al (2022) Clinical application of modified frailty index in predicting complications after hip fracture in the elderly. Chin J Mult Organ Dis Elderly 21:481. https://doi.org/10.11915/j.issn.1671-5403.2022.07.104

    Article  Google Scholar 

  29. Tram MK, O’Connor CM, Qian AS et al (2022) Frailty is associated with increased 30-day adverse events and hospitalization costs after primary total hip arthroplasty. J Arthroplasty 37:S925–S930.e4

    Article  PubMed  Google Scholar 

  30. Zhou Y, Wang L, Cao A et al (2022) Modified frailty index combined with a prognostic nutritional index for predicting postoperative complications of hip fracture surgery in elderly. J Invest Surg 35:1739–1746. https://doi.org/10.1080/08941939.2022.2101166

    Article  PubMed  Google Scholar 

  31. Song Y, Wu Z, Huo H et al (2022) The impact of frailty on adverse outcomes in geriatric hip fracture patients: a systematic review and meta-analysis. Front Public Health 10:890652. https://doi.org/10.3389/fpubh.2022.890652

    Article  PubMed  PubMed Central  Google Scholar 

  32. Folsom AR, Boland LL, Cushman M et al (2007) Frailty and risk of venous thromboembolism in older adults. J Gerontol A Biol Sci Med Sci 62:79–82

    Article  PubMed  Google Scholar 

  33. Lutsey PL, Windham BG, Misialek JR et al (2020) Long-term association of venous thromboembolism with frailty, physical functioning, and quality of life: the atherosclerosis risk in communities study. J Am Heart Assoc 9:e015656. https://doi.org/10.1161/JAHA.119.015656

    Article  PubMed  PubMed Central  Google Scholar 

  34. Ebrahimian S, Lee C, Tran Z et al (2022) Association of frailty with outcomes of resection for colonic volvulus: a national analysis. PLoS ONE 17:e0276917. https://doi.org/10.1371/journal.pone.0276917

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Phan K, Kim JS, Lee NJ et al (2017) Frailty is associated with morbidity in adults undergoing elective anterior lumbar interbody fusion (ALIF) surgery. Spine J 17:538–544 

    Article  PubMed  Google Scholar 

  36. Putthapiban P, Vutthikraivit W, Rattanawong P et al (2020) Association of frailty with all-cause mortality and bleeding among elderly patients with acute myocardial infarction: a systematic review and meta-analysis. J Geriatr Cardiol 17:270–278. https://doi.org/10.11909/j.issn.1671-5411.2020.05.006

    Article  PubMed  PubMed Central  Google Scholar 

  37. Proietti M, Romiti GF, Raparelli V et al (2022) Frailty prevalence and impact on outcomes in patients with atrial fibrillation: a systematic review and meta-analysis of 1,187,000 patients. Ageing Res Rev 79:101652

    Article  CAS  PubMed  Google Scholar 

  38. Yoon JY, Kim S, Chang JS et al (2020) Venous thromboembolism after delayed surgery for a hip fracture: a retrospective cohort study. Geriatr Gerontol Int 20:1151–1156. https://doi.org/10.1111/ggi.14055

    Article  PubMed  Google Scholar 

  39. Imamura K, Yamamoto S, Suzuki Y et al (2023) Comparison of the association between six different frailty scales and clinical events in patients on hemodialysis. Nephrol Dial Transplant 38:455–462. https://doi.org/10.1093/ndt/gfac047

    Article  PubMed  Google Scholar 

  40. Sukkriang N, Punsawad C (2020) Comparison of geriatric assessment tools for frailty among community elderly. Heliyon 6:e04797. https://doi.org/10.1016/j.heliyon.2020.e04797

    Article  PubMed  PubMed Central  Google Scholar 

  41. Baldawi M, Awad ME, McKelvey G et al (2023) Neuraxial anesthesia significantly reduces 30-day venous thromboembolism rate and length of hospital stay in primary total hip arthroplasty: a stratified propensity score-matched cohort analysis. J Arthroplasty 38:108–116

    Article  PubMed  Google Scholar 

  42. Wang X, Jiang Z, Li Y et al (2022) Prevalence of preoperative Deep Venous Thrombosis (DVT) following elderly intertrochanteric fractures and development of a risk prediction model. BMC Musculoskelet Disord 23:417. https://doi.org/10.1186/s12891-022-05381-y

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Funding

No funding was received for this study.

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Author notes

  1. Haixia Zhang and Fang Wu contributed equally to this work.

Authors and Affiliations

  1. Department of Anesthesia and Perioperative Medicine, General Hospital of Ningxia Medical University, Yinchuan, 750004, China

    Haixia Zhang, Fang Wu & Yongchao Liu

  2. Department of Hand, Foot and Ankle Surgery, General Hospital of Ningxia Medical University, Yinchuan, 750004, China

    Jianbin Sun

  3. Burn and Plastic Surgery Department, General Hospital of Ningxia Medical University, Yinchuan, 750004, China

    Zifu Zhou & Xuejun Wu

  4. Department of Anesthesiology, People’s Hospital of Ningxia Hui Autonomous Region, No. 301, Zhengyuan Beijie, Jinfeng District, Yinchuan, 750004, China

    Bin Liang

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Contributions

HZ, FW, and BL conceived the study. HZ and FW performed a database search, literature identification, quality evaluation, and data extraction, HZ, JS, YL, ZZ, and XW performed statistical analyses and interpreted the data. HZ and FW drafted the manuscript. BL critically revised the manuscript. All authors approved the submission.

Corresponding author

Correspondence to Bin Liang.

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Zhang, H., Wu, F., Sun, J. et al. The impact of frailty evaluation on the risk of venous thromboembolism in patients with hip fracture following surgery: a meta-analysis. Aging Clin Exp Res 35, 2413–2423 (2023). https://doi.org/10.1007/s40520-023-02529-1

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