- Operative Timing:
- Anesthesia:
- in elective hip surgery there is 3 fold decrease in thromboembolic complications from the use of regional anesthesia and SCDs (Clin-Orthop. 1989 Oct (247): 163-7)
- in the study by Koval et al 1999, there was similar mortality rates between patients undergoing spinal vs general anesthesia;
- in the study by TB Gilbert et al. (Am J Orthop 2000 Jan;29(1):25-35), the authors performed a multicenter, noninterventional, observational trial,
provided an opportunity to investigate the effects of anesthetic technique on the long-term outcome of elderly pts after hip x repair;
- of 741 enrolled patients who completed the study, 430 and 311 patients received spinal anesthesia or general anesthesia;
- the authors noted that general anesthesia was at least as efficacious as spinal anesthesia, and possibly better, in affording good long-term outcome;
- references:
- Spinal or general anaesthesia for surgery of the fractured hip A prospective study of mortality in 578 patients.
- Analgesia following femoral neck surgery. Lateral cutaneous nerve block as an alternative to narcotics in the elderly.
- Hip fracture in the elderly: the effect of anesthetic technique. KJ Koval MD et al. Orthopedics. Jan 1999. Vol 22 No 1. p 31.
- The medical and economic impact of preoperative cardiac testing in elderly patients with hip fractures.
- Timothy J. Hinlicky, &c., Appellant, v. David C. Dreyfuss, et al., Respondents.
- Medical Malpractice. A Case of Inadequate Informed Consent.
- How Much of a Cardiac Work-up Is Too Much?
- Board Investigations and Actions
- Timothy J. Hinlicky, &c., Appellant, v. David C. Dreyfuss, et al.,Respondents.
- $4 Million Dollar Settlement - Hypoxic Brain Injury in an Adult; Improper Surgical Clearance
- Preoperative Testing and Clearance
- JOHN F. RAUCH, ADMINISTRATOR OF THE ESTATE OF BONNIE J.RAUCH, DECEASED,Appellant IN THE SUPERIOR COURT OF PENNSYLVANIA
v. HENRIK MIKE-MAYER, M.D., MICHAEL CLARK, M.D., MICHAEL FEFFER, M.D., MERCY ANESTHESIA GROUP, P.C.,
- Medical Malpractice. A Case of Inadequate Informed Consent
- Troponin T as a predictive marker of morbidity in patients with fractured neck of femur.
Managemen of Anemia:
-
erythropoietin:
- may be used to help increase the hematocrit in hip frx patients;
- try 5 daily doses of 150 IU/kg of Epoetin alfa plus 100 mg of parental iron;
- references:
- Parental iron and recombinant human erythropoietin therapy to stimulate erythropoiesis in patients undergoing repair of hip fractures.
LT Goodnough et al. Hematology. Vol 1. 1996. p 163-166.
- DVT occurance in hip frx surgery:
- Mortality:
- several studies have been performed to evaluate hip fracture mortality, and as expected the reported rates
in each of these studies depends on the comorbidity of the patient population;
- one month mortality is about 5-7 %, one year mortality is about 12-20% (lower percentage for metally alert patients);
- references:
-
Mortality after Fracture of the Hip in Patients Who Have End-Stage Renal Disease.
-
Hip fracture mortality. Relation to age, treatment, preoperative illness, time of surgery, and complications.
-
Rate of mortality for elderly patients after fracture of the hip in the 1980's.
-
Prospective, multi-centre trial of mortality following general or spinal anaesthesia for hip fracture surgery in the elderly.
-
Postoperative complications and mortality associated with operative delay in older patients who have a fracture of the hip.
-
Survival experience of aged hip fracture patients.
-
Hip fractures in the elderly: predictors of one year mortality.
-
Mortality risk after hip fracture.
-
Hip fractures after falls in hospital: A retrospective observational cohort study.
Delay to surgery prolongs hospital stay in patients with fractures of the proximal femur.
Patient Risk Factors, Operative Care, and Outcomes Among Older Community-Dwelling Male Veterans with Hip Fracture
Preoperative cardiac evaluation of patients with acute hip fracture.
