The prevalence of major adverse cardiovascular events after hip fracture surgery in older adults: a systematic review

The reported incidence of major adverse cardiovascular events(MACE) following hip fracture surgery in older adults remains unclear, with existing studies exhibiting substantial heterogeneity. We conducted a systematic review in accordance with PRISMA 2020 guidelines. PubMed, Web of Science, EMBASE, Cochrane Library, and four Chinese databases were searched from inception to September 2025. Retrospective or prospective cohort studies reporting MACE incidence in patients aged ≥ 60 years after hip fracture surgery were eligible. Due to extreme statistical heterogeneity (I 2 > 95%) identified during pre-synthesis, a descriptive synthesis was performed instead of a meta-analysis. Study characteristics and MACE incidence were summarized using descriptive statistics, presented as medians with interquartile ranges (IQR) and overall ranges. Sixteen retrospective cohort studies involving 1,591,703 patients were included. The reported MACE incidence varied widely, from 0.08% to 14.89%. Heart failure showed the highest median incidence among component events (9.55%, IQR 6.73–12.37%); however, this estimate is derived from only four studies with a small total sample ( n = 2,230) and should be interpreted with caution. Stratification by fracture type and surgical method revealed only minor median differences with broad and overlapping ranges, suggesting that anatomical and procedural factors alone do not explain the observed variability. The extensive variability in reported MACE rates underscores definitional inconsistency and patient physiological heterogeneity (e.g. frailty) as fundamental issues. Future research must prioritize standardized MACE definitions. Our findings suggest that patient-centered risk stratification, incorporating frailty assessment, may hold promise for perioperative cardiovascular protection; however, this hypothesis requires formal testing in future prospective studies with standardized MACE definitions.