Indications: - Moderate evidence supports that hip fracture surgery within 48 hours of admission is associated with better outcomes (1).
- Limited evidence supports not delaying hip fracture surgery for patients on aspirin and/or clopidogrel. The systematic review suggests at worse that there is no advantage to this practice or that in fact the advantage is for patients where surgery is not delayed (1).
Measurments: - Charlson Comorbidity Index (CCI): link (3).
- Notthingham Hip Fracture Score (NHFS): link (2).
- Strong evidence supports regional analgesia (e.g. ultrasound-guided fascia iliaca-block) to improve preoperative pain control in patients with hip fracture (1).
- Strong evidence supports similar outcomes for general or spinal anesthesia for patients undergoing hip fracture surgery (1).
Future risks:- Given the significant established risk factors for VTE present in this patient population including age, presence of hip fracture, major surgery, delays to surgery and the potential serious consequences of failure to provide prophylaxis in the hip fracture population, it is recommended that VTE prophylaxis be used (1).
- Strong evidence supports a blood transfusion threshold of no higher than 8 g/dl in asymptomatic postoperative hip fracture patients (even those with cardiovascular disease or risk factors) (1).Â
- American Academy of Orthopedic Surgeons. Management of hip fractures in the elderly, evidence-based clinical practice guideline. 2014: link.
- I. K. Moppett et al. Nottingham Hip Fracture Score: longitudinal and multi-centre assessment. British Journal of Anaesthesia. 2012: full text | pdf.
- ME Charlson et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J. Chron Dis. 1987;40:373-83: abstract.
|
|
