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Anesthesia, Medical Considerations, and Timing for Femoral Neck Frx

- Considerations:
    - assessment of risk:
    - operative timing:
    - anesthesia: 
         - in elective hip surgery there is 3-fold decrease in thromboembolic complications from the use of regional anesthesia and SCDs (COOR 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 Gilbert TB, et al. (2000), 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;
                 - 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.  
                 - Spinal anesthesia versus general anesthesia for hip fracture repair: a longitudinal observation of 741 elderly patients during 2-year follow-up.

- Managemen of Anemia:
    - Basal haemoglobin levels as prognostic factor for early death in elderly patients with a hip fracture - A twenty year observation study.
    - 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;
           - reference:
                  - Parental iron and erythropoietin to stimulate erythropoiesis in patients undergoing repair of hip frx. Goodnough. Hematology. 1996;1:163-166.

- DVT risk reduction - 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.

Patient Risk Factors, Operative Care, and Outcomes Among Older Community-Dwelling Male Veterans with Hip Fracture

Original Text by Clifford R. Wheeless, III, MD.

Last updated by Clifford R. Wheeless, III, MD on Sunday, April 12, 2015 10:48 am

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