International Fragility Fracture Network Delphi consensus statement on the principles of anaesthesia for patients with hip fracture

White, Stuart; Altermatt, Fernando; Barry, Jeffrey J.; Ben‐David, Bruce; Coburn, Mark; Coluzzi, Flaminia; Degoli, M.; Dillane, Derek; Foss, Nicolai Bang; Gelmanas, Arūnas; Griffiths, R.; Karpetas, Georgios; Kim, J.-H.; Kluger, M. T.; Lau, Perry; Matot, Idit; McBrien, M. E.; McManus, Shauna; Montoya-Pelaez, L. F.; Moppett, Iain; Parker, Martyn J.; Porrill, O; Sanders, Robert D.; Shelton, Cliff; Sieber, Frederick E.; Trikha, Anjan; Xuebing, X.

doi:10.1111/anae.14225

Cited by 68 publications

(62 citation statements)

References 60 publications

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“…A recently published consensus paper with advices for basic standards of anaesthetic care in patients with hip fracture has pointed out seven important principles. 16 Several of these principles are already covered in the German national guidelines issued by the German Society for Anaesthesiology and Intensive Care Medicine, 44 even if not specifically focused on patients with hip fracture. This refers to the multidisciplinary care for all surgical patients, the principles that an appropriately experienced anaesthetist should perform anaesthesia, 45 the use of standard monitoring for each patient and advanced intraoperative monitoring (eg, invasive blood pressure measurement) in high-risk patients.…”

Section: Discussionmentioning

confidence: 99%

“…So far, no specific anaesthesia management has been recommended for hip fracture surgery. 16 The commonly most applied anaesthesia techniques for hip fracture surgery represent spinal and general anaesthesia. 17 Several studies have reviewed the evidence for these two techniques and showed partially contradictory results with limited quality.…”

Section: Introductionmentioning

confidence: 99%

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Improve hip fracture outcome in the elderly patient (iHOPE): a study protocol for a pragmatic, multicentre randomised controlled trial to test the efficacy of spinal versus general anaesthesia

et al. 2018

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IntroductionHip fracture surgery is associated with high in-hospital and 30-day mortality rates and serious adverse patient outcomes. Evidence from randomised controlled trials regarding effectiveness of spinal versus general anaesthesia on patient-centred outcomes after hip fracture surgery is sparse.Methods and analysisThe iHOPE study is a pragmatic national, multicentre, randomised controlled, open-label clinical trial with a two-arm parallel group design. In total, 1032 patients with hip fracture (>65 years) will be randomised in an intended 1:1 allocation ratio to receive spinal anaesthesia (n=516) or general anaesthesia (n=516). Outcome assessment will occur in a blinded manner after hospital discharge and inhospital. The primary endpoint will be assessed by telephone interview and comprises the time to the first occurring event of the binary composite outcome of all-cause mortality or new-onset serious cardiac and pulmonary complications within 30 postoperative days. In-hospital secondary endpoints, assessed via in-person interviews and medical record review, include mortality, perioperative adverse events, delirium, satisfaction, walking independently, length of hospital stay and discharge destination. Telephone interviews will be performed for long-term endpoints (all-cause mortality, independence in walking, chronic pain, ability to return home cognitive function and overall health and disability) at postoperative day 30±3, 180±45 and 365±60.Ethics and disseminationiHOPE has been approved by the leading Ethics Committee of the Medical Faculty of the RWTH Aachen University on 14 March 2018 (EK 022/18). Approval from all other involved local Ethical Committees was subsequently requested and obtained. Study started in April 2018 with a total recruitment period of 24 months. iHOPE will be disseminated via presentations at national and international scientific meetings or conferences and publication in peer-reviewed international scientific journals.Trial registration numberDRKS00013644; Pre-results

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Improve hip fracture outcome in the elderly patient (iHOPE): a study protocol for a pragmatic, multicentre randomised controlled trial to test the efficacy of spinal versus general anaesthesia

et al. 2018

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“…Several ongoing large-scale randomized controlled trials (RCTs) should provide future guidance on the best anesthesia technique for hip surgery in the elderly [83][84][85]. Regardless of the type of anesthesia chosen, anesthesia should be carried out by experienced anesthesiologists who are trained to manage the perioperative care of geriatric patients [62,86]. Anesthesiologists should then base the choice of anesthetic on patient preferences, comorbidities, and potential postoperative complications.…”

Section: Mode Of Anesthesiamentioning

confidence: 99%

Anesthetic management of geriatric patients

Lim

2020

Korean J Anesthesiol

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The number of elderly patients who frequently access health care services is increasing worldwide. While anesthesiologists are developing the expertise to care for these elderly patients, areas of concern remain. We conducted a comprehensive search of major international databases (PubMed, Embase, and Cochrane) and a Korean database (KoreaMed) to review preoperative considerations, intraoperative management, and postoperative problems when anesthetizing elderly patients. Preoperative preparation of elderly patients included functional assessment to identify preexisting cognitive impairment or cardiopulmonary reserve, depression, frailty, nutrition, polypharmacy, and anticoagulation issues. Intraoperative management included anesthetic mode and pharmacology, monitoring, intravenous fluid or transfusion management, lung-protective ventilation, and prevention of hypothermia. Postoperative checklists included perioperative analgesia, postoperative delirium and cognitive dysfunction, and other complications. A higher level of perioperative care was required for older surgical patients, as multiple chronic diseases often makes them prone to developing postoperative complications, including functional decline and loss of independence. Although the guiding evidence remains poor so far, elderly patients have to be provided optimal perioperative care through close interdisciplinary, interprofessional, and cross-sectional collaboration to minimize unwanted postoperative outcomes. Furthermore, along with adequate anesthetic care, well-planned postoperative care should begin immediately after surgery and extend until discharge.

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“…AAOS 2014, Kristensen et al 2016, NICE 2017, Pincus et al 2017, Aprato et al 2018, White et al 2018. The main aim of this study was to find out whether implementation of an HFU was associated with improved outcome.…”

mentioning

confidence: 99%

Results after introduction of a hip fracture care pathway: comparison with usual care

et al. 2020

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International Fragility Fracture Network Delphi consensus statement on the principles of anaesthesia for patients with hip fracture

Cited by 68 publications

References 60 publications

Improve hip fracture outcome in the elderly patient (iHOPE): a study protocol for a pragmatic, multicentre randomised controlled trial to test the efficacy of spinal versus general anaesthesia

Improve hip fracture outcome in the elderly patient (iHOPE): a study protocol for a pragmatic, multicentre randomised controlled trial to test the efficacy of spinal versus general anaesthesia

Anesthetic management of geriatric patients

Results after introduction of a hip fracture care pathway: comparison with usual care

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