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.
Systematic Review
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)./r/nThis 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./r/nThe 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)./r/nThe 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.
