Complications following hip fracture surgery in end-stage kidney disease patients receiving dialysis: A systematic review and meta-analysis of cohort studies.

Abstract

Hip fracture patients have significant morbidity and mortality, with worse outcomes in end-stage kidney disease (ESKD) patients receiving dialysis. This study evaluates and quantifies the risk of mortality and complications in dialysis patients undergoing surgery for hip fractures. A systematic review of studies investigating complications after surgery for hip fractures in ESKD patients receiving dialysis was performed across various databases. Mortality (30-day or longer) was the primary outcome. Thirty studies encompassing 23,024 dialysis patients were included, most of which had a low risk of bias (n = 26; 87 %). Thirty-day (RR 2.2; CI 95 %: 1.5, 3.2 and HR 2.3; CI 95 %: 1.7, 3.0) and overall mortality (RR 1.9; CI 95 %: 1.6, 2.2) were two-fold greater in dialysis patients. There was also an increased risk of surgical site infection (RR 1.6. CI 95 %: 1.3, 2.0), major adverse cardiac events (RR 1.9. CI 95 %: 1.3, 3.0), and sepsis (RR 1.9. CI: 1.5, 2.2) in this cohort compared to a non-dialysis cohort. Patients receiving dialysis experience approximately two-fold greater mortality after hip fracture surgery compared to patients not receiving dialysis. Dialysis patients face higher rates of complications after surgery, notably wound infection, major adverse cardiac events, and sepsis. Results from this study provide quantitative estimates for perioperative counselling of patients alongside families. While some tools aid in predicting post-operative outcomes, further research may refine risk stratification in this cohort. Additional evidence is required to establish evidence-based models of care that optimise the peri-operative health of dialysis patients.