Effects of Peri-Operative Glucocorticoids in Hip Fracture Patients on Post-Operative Outcomes: Systematic Review Protocol.

Abstract

Hip fracture patients are often elderly and frail, with a high burden of comorbidity, placing them at substantial risk of post-operative delirium and other complications. Post-operative delirium is associated with prolonged recovery, functional decline, increased mortality and higher healthcare costs. Peri-operative glucocorticoids are widely used in peri-operative care and may modulate the inflammatory response associated with surgery, potentially reducing delirium and related adverse outcomes. This systematic review aims to evaluate the effects of peri-operative glucocorticoids on post-operative delirium in adults undergoing hip fracture surgery, as well as associated benefits and harms. This protocol follows Cochrane methodology and PRISMA recommendations. The research question will be structured using the PICO framework. Randomised controlled trials and observational studies comparing peri-operative glucocorticoids with placebo or no peri-operative glucocorticoids will be included. The primary outcome is post-operative delirium incidence. Secondary outcomes include delirium severity, post-operative pain, morphine equivalents, patient satisfaction, length of stay, other adverse events as defined by author, and mortality. A comprehensive literature search will be conducted in multiple databases, supplemented by reference screening and searches for ongoing or unpublished studies. Meta-analysis will be performed where appropriate. Heterogeneity will be assessed, and subgroup or sensitivity analyses conducted as needed. Risk of bias and quality of evidence will be assessed using validated tools, and certainty of evidence will be evaluated using GRADE. This review will synthesise current evidence on the efficacy and safety of peri-operative glucocorticoids in hip fracture surgery, with a particular focus on post-operative delirium. The findings may inform clinical practise and guide future research in this vulnerable patient population.