Pre-operative pulmonary assessment for patients with hip fracture

Abstract

Hip fracture is a common injury among the elderly. Although patients who receive hip fracture surgery carry the best functional recovery compared to other treatment modalities, the presence of postoperative pulmonary complications, such as atelectasis, pneumonia, and pulmonary thromboembolism, may contribute to increased length of hospital stay, perioperative morbidity, and mortality. This review aims to provide evidence-based recommendations for preoperative assessment and perioperative strategies to reduce the risk of pulmonary complications after hip fracture surgery. Clinical assessment and basic laboratory results are sufficient to stratify the risk of postoperative pulmonary complications. Well-documented risk factors for pulmonary complications include advanced age, poor general health status, current infections, pre-existing cardiopulmonary diseases, hypoalbuminemia, and impaired renal function. Apart from optimizing the patient's medical conditions, interventions such as lung expansion maneuvers and thromboprophylaxis have been proven to be effective in reducing the risk of pulmonary complications after hip fracture surgery.

Treatment of Protrusio Fractures of the Acetabulum in Patients 70 Years and Older

“…At the final follow-up for the 26 patients with minimum of 12 months follow-up, radiographic grades were excellent in 15, good in 3, poor in 3, and 5 patients had a total hip arthroplasty. At latest follow-up (minimum of 12 months after surgery), the mean modified Merle d'Aubigne score was 16 (9)(10)(11)(12)(13)(14)(15)(16)(17)(18); categorized as good. The breakdown of this score was as follows: the mean ambulation score was 4.9 (0-6), the mean Range of Motion score was 5.4 (4)(5)(6), and the mean pain score was 5.7 (3)(4)(5)(6).…”

“…This is not dissimilar to our standard protocol for geriatric hip fractures. [6][7][8][9] The goal of this assessment was to minimize intraoperative hypotensive events, judiciously manage intraoperative fluid replacement, and optimize hemoglobin/hematocrit facilitated by central venous catheter and arterial line monitoring performed by the anesthesia service. All cases were performed in the supine position on a pelvic fracture table capable of applying a mechanical lateral distraction to the hip.…”

Management of Postoperative Complications

“…Attention to good pulmonary practices with the use of effective positioning, a bedside incentive spirometer to prevent atelectasis, and avoidance of oversedation are beneficial measures to prevent pneumonia. 36 Oxygen supplementation can minimize the effects of hypoxia.…”

Early surgery increases mitochondrial DNA release and lung injury in a model of elderly hip fracture and chronic obstructive pulmonary disease

“…It is understood that hip fracture and accompanying early surgery has an adverse effect on the lungs of elderly patients, and postoperative lung infections are associated with impaired lung conditions (9). Chronic lung disease is a compelling reason for delaying surgery and patients often require additional treatments and tests that are time-consuming.…”