What are the admission criteria for a patient with a hip fracture undergoing orthopedic (ortho) surgery?

From the Guidelines

Patients with hip fractures should be admitted and undergo orthopedic surgery within 48 hours of injury, with a comprehensive preoperative assessment and preparation, including pain relief, fluid management, and optimization of chronic medical conditions, to minimize morbidity and mortality. The admission criteria for a patient with a hip fracture undergoing orthopedic surgery should prioritize a multidisciplinary approach, including orthogeriatricians, to manage the patient's overall health and minimize complications 1. The following key elements should be considered:

• Preoperative assessment and preparation, including pain relief, fluid management, and optimization of chronic medical conditions 1
• Systematic multidisciplinary and comprehensive admission assessment of the patient's medical conditions, including investigations for modifiable variables such as malnutrition, electrolyte or volume disturbances, anaemia, cardiac or pulmonary diseases, dementia, and delirium control 1
• Preoperative investigations, including chest X-ray, ECG, full blood count, clotting studies, final blood group, renal function, and assessment of cognitive baseline function 1
• Safe and timely transfer from the emergency room to an orthogeriatric ward and definitive treatment, including early surgery within 24-48 hours after admission, to reduce short-term and mid-term mortality rates and minor and major medical complications 1
• Consideration of anticoagulation therapy, including the management of patients taking aspirin, clopidogrel, or warfarin, to minimize the risk of bleeding and thromboembolic events 1
• Nutrition and hydration support, including the use of oral nutritional supplements (ONS) to reduce the risk of postoperative complications and promote recovery 1. It is essential to prioritize the patient's overall health and well-being, minimizing morbidity and mortality, and ensuring a comprehensive and multidisciplinary approach to their care 1.

From the Research

Admission Criteria for Hip Fracture Patients Undergoing Ortho Surgery

The admission criteria for patients with hip fractures undergoing orthopedic surgery are not explicitly stated in the provided studies. However, the following points can be considered:

• Patients with hip fractures are considered high-risk for bleeding, especially if they have comorbidities or are taking anticoagulation medications 2.
• The American Academy of Orthopaedic Surgeons provides guidelines for the management of hip fractures, including recommendations for preoperative discontinuation and postoperative resumption of anticoagulant medications 2.
• Patients undergoing hip fracture surgery may require thromboprophylaxis to prevent venous thromboembolism (VTE), with options including enoxaparin, fondaparinux, and other anticoagulant agents 3, 4, 5.
• Preoperative steroids may be used to decrease the risk of postoperative delirium in geriatric patients undergoing hip fracture surgery 6.

Key Considerations for Admission

• Comorbidities and anticoagulation medications should be carefully managed in patients with hip fractures 2.
• Thromboprophylaxis should be considered to prevent VTE in patients undergoing hip fracture surgery 3, 4, 5.
• Preoperative steroids may be beneficial in reducing the risk of postoperative delirium in geriatric patients 6.
• The choice of VTE prophylactic agent may depend on individual patient factors and the specific surgery being performed 5.