Elderly hip fracture patients need comprehensive preoperative evaluation and management, often involving multiple specialties, because of their frequent comorbidities and complications. However, surgery should not be unnecessarily delayed.
While finding and addressing significant problems is an appropriate goal, a prolonged work-up, or time spent on issues that cannot be promptly improved, may delay surgery without benefit for the patient. Current evidence suggests that most patients with femoral neck fractures have better results if operated within 48 hours after injury. Patients with more than three medical comorbidities may benefit from a longer attempt at medical optimization, but generally should have surgery within 4 days.
Postoperatively, 20% or more of elderly patients with hip fractures will develop at least one medical complication (most commonly cardiac or pulmonary). Frequency of complications is predictably higher in those patients with more severe comorbidities, and they have expectedly higher risks of postoperative death. Involvement of anesthesia and medical consultants in the perioperative care of these patients makes management easier, and may improve results.
Routine perioperative care for the elderly hip fracture patient should include:
Predicting whether a patient can successfully return home may be difficult, but here are some guidelines that may be helpful.
Studies have shown that as few as 50% of patients were able to return home, and that mortality rates are lower in those that do return home compared with rates in those that are transferred to nursing homes or rehabilitation centers.
Predictors of a patient’s ability to return home include: