Enhanced rehabilitation and care models for adults with dementia following hip fracture surgery.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2020;8(6):11 Cochrane Database Syst Rev. 2020 Feb 7;2:CD010569.Was bedeutet das für meine Praxis?
Meta-analysis findings suggest that enhanced rehabilitation does not provide any significant advantage over usual post-operative care in elderly dementia patients undergoing hip fracture surgery, specifically with regards to the risk of mortality and length of stay. The pooled risk of post-operative delirium was, however, found to be significantly in favour of the enhanced rehabilitation group. This study was limited by the lack of sufficient data for pooling in the primary outcomes, lack of blinding in the included studies, lack of reporting of surgical fixation methods and the lack of dementia diagnosis with a valid diagnostic tool in the majority of included studies. A high-quality randomized trial is of interest.
Zusammenfassung der Studie
Five hundred and fifty-five patients from 7 trials were included in this meta-analysis comparing enhanced care and rehabilitation models and standard post-operative rehabilitation in elderly dementia patients undergoing surgery for proximal hip fractures. The primary outcomes of interest were health-related quality of life, activities of daily living and functional performance measures. Secondary outcomes of interest included measures of cognitive function, behaviour, pain, mortality, adverse events, and health and social resources. Insufficient evidence of health-related quality of life, activities of daily living, functional performance, cognitive function, behaviour and pain outcomes were available, preventing the pooling and meta-analysis of data. Pooled results for risk of all-cause mortality during hospitalization, 3 months and 12 months post-operation were not significant different between the enhanced care and usual care groups. Pooled results for length of stay were not significantly different between groups. Pooled results for post-operative delirium at discharge were significantly in favour of the enhanced care group compared to the usual care group. The sub-group analysis of delirium during hospitalization was not significantly different between the geriatrician-led in-patient management sub-group and the orthopaedic-led in-patient management sub-group.
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