Perioperative Implications of Surgery in Elderly Patients with Hip Fractures: An Evidence-Based Review (Clinical FEATURE‪)‬

Hip fractures are frequent injuries amongst older patients with osteoporosis and account for about 76,000 cases in the UK per year according to the National Hip Fracture Database (NHFD 2010). A review that examined the extensive hip fracture literature published in the English language between 1980 and 2009 concerning hip fracture prevalence trends suggested that hip fractures will remain a serious global health issue (Marks 2010). Hip fractures are a major cause of morbidity, mortality and loss of independence in the elderly. These fractures pose a major public healthcare burden and continue to consume large portions of healthcare resources. Surgical fixation of fractured hips remains the standard of care to allow early mobilisation and a return to independence. Timely surgery limits the period of recumbence and helps to prevent pressure sores, urinary tract infections, deep vein thromboses and pulmonary complications including atelectases, pneumonia and pulmonary emboli. Surgical intervention is considered superior in medically-fit elderly patients (Parker et al 2000, Beaupre et al 2005), and ideally this should be completed within 48 hours for the majority of patients with hip fracture (Egol&Strauss 2009). Even in the absence of co-morbidity, the altered physiological state of the older person can present challenges for the anaesthetist and the rest of the perioperative team. Operative management in this population carries its own set of problems and implications, and these are discussed below.