New guidelines on diagnosing and treating hip fractures in patients age 65 and older emphasize the importance of reducing postoperative delirium—a common side effect of hip-fracture surgery, and one that does not bode well for patient outcomes. Patients who experience postoperative delirium are less likely to return to their pre-injury function level. They also have an increased risk of mortality, studies report. The guideline document contains several other strong recommendations for this patient cohort.
Released by the American Academy of Orthopaedic Surgeons (AAOS), “the guideline provides evidence for orthopaedic surgeons and other physicians to argue for treatments that provide the best care for this growing segment of patients,” says Steven A. Olson, MD, FACS, a professor in Duke's Department of Orthopaedic Surgery who served on the work group that developed the clinical practice guideline (CPG). “These recommendations can also form the core of a care bundle for these patients.”
The guideline, titled, “Management of Hip Fractures in the Elderly,” also strongly recommends:
- Hip-fracture surgery within 48 hours of hospital admission
- Preoperative regional analgesia to reduce pain
- Intensive physical therapy following discharge
- An osteoporosis evaluation, as well as vitamin D and calcium supplements.
Dr. Olson says updated guidelines were needed because hip-fracture occurrences are increasing due to the aging population and the increasing prevalence of osteoporosis. Additionally, hip fractures ranked 13th on the 20 most expensive diagnoses for Medicare in 2011.
Of note, other organizations contributed to this guideline update, including the American Society of Geriatrics, the American Association of Anesthesiologists, and the Orthopaedic Trauma Association. “This multidisciplinary approach helped give the CPG a patient-centered orientation,” Dr. Olson says.
In creating the guideline, Dr. Olson says the evidence spoke for itself. “In areas with moderate and limited evidence, discussions revolved around the language of the rationale paragraphs that followed the recommendations,” he says. “Although several members of the work group wanted to use stronger language, we realized that overstating the evidence in the rationale would ultimately weaken the guideline’s perception.”