Safety guideline: reducing the risk from cemented hemiarthroplasty for hip fracture 2015

Griffiths, R.; White, Stuart; Moppett, I. K.; Parker, Martyn J.; Chesser, T.J.S.; Costa, Matt L; Johansen, Antony; Wilson, Henrietta; Timperley, A. John

doi:10.1111/anae.13036

Cited by 85 publications

(24 citation statements)

References 9 publications

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“…All three units have policies mapped to national U.K. standards (National Institute for Health and Care Excellence [16], British Orthopaedic Association Standards for Trauma [17], Association of Anaesthetists of Great Britain and Ireland [18, 19] and Best Practice Tariff [20]).…”

Section: Methodsmentioning

confidence: 99%

Tight intra-operative blood pressure control versus standard care for patients undergoing hip fracture repair – Hip Fracture Intervention Study for Prevention of Hypotension (HIP-HOP) trial: study protocol for a randomised controlled trial

Moppett

White

Griffiths

et al. 2017

Trials

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BackgroundHypotension during anaesthesia for hip fracture surgery is common. Recent data suggest that there is an association between the lowest intra-operative blood pressure and mortality, even when adjusted for co-morbidities. This is consistent with data derived from the wider surgical population, where magnitude and duration of hypotension are associated with mortality and peri-operative complications. However, there are no trial to data to support more aggressive blood pressure control.Methods/designWe are conducting a three-centre, randomised, double-blinded pilot study in three hospitals in the United Kingdom. The sample size will be 75 patients (25 from each centre). Randomisation will be done using computer-generated concealed tables. Both participants and investigators will be blinded to group allocation. Participants will be aged >70 years, cognitively intact (Abbreviated Mental Test Score 7 or greater), able to give informed consent and admitted directly through the emergency department with a fractured neck of the femur requiring operative repair. Patients randomised to tight blood pressure control or avoidance of intra-operative hypotension will receive active treatment as required to maintain both of the following: systolic arterial blood pressure >80% of baseline pre-operative value and mean arterial pressure >75 mmHg throughout. All participants will receive standard hospital care, including spinal or general anaesthesia, at the discretion of the clinical team. The primary outcome is a composite of the presence or absence of defined cardiovascular, renal and delirium morbidity within 7 days of surgery (myocardial injury, stroke, acute kidney injury, delirium). Secondary endpoints will include the defined individual morbidities, mortality, early mobility and discharge to usual residence.DiscussionThis is a small-scale pilot study investigating the feasibility of a trial of tight intra-operative blood pressure control in a frail elderly patient group with known high morbidity and mortality. Positive findings will provide the basis for a larger-scale study.Trial registrationISRCTN Registry identifier: ISRCTN89812075. Registered on 30 August 2016.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-017-2066-5) contains supplementary material, which is available to authorized users.

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Section: Methodsmentioning

confidence: 99%

Tight intra-operative blood pressure control versus standard care for patients undergoing hip fracture repair – Hip Fracture Intervention Study for Prevention of Hypotension (HIP-HOP) trial: study protocol for a randomised controlled trial

Moppett

White

Griffiths

et al. 2017

Trials

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“…The anesthesiologist and the anesthesiology nurse are also responsible for correct administration of perioperative antibiotics. The orthopedic surgeon and the anesthesiologist should discuss the scope of the planned surgery, including measures taken when using bone cement 16 , and measures taken when reversal of anticoagulants are needed 14 . The orthopedic surgeon should consider the surgical treatment options according to hospital guidelines and current evidence 6,17 .…”

Section: Anesthesiologist and Orthopedic Surgeonmentioning

confidence: 99%

Team Approach: Multidisciplinary Treatment of Hip Fractures in Elderly Patients

et al. 2019

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Take Home Points • Patients with hip fractures are best managed by a multidisciplinary team. • The multidisciplinary team consists of orthogeriatrician, orthopedic surgeon, anesthesiologist, orthopedic and/or geriatric nurse, occupational therapist, physiotherapist, clinical pharmacologist and may also include other professions, such as endocrinologist, nutritional therapist, and social worker. • Key factors include perioperative assessment and early surgery, comprehensive geriatric assessment (CGA), multidisciplinary inward assessment including discharge planning, treatment and rehabilitation, and secondary fracture prevention. • Current evidence show that older people receiving multidisciplinary treatment for hip fracture, CGA, and systematic secondary fracture prevention, have reduced morbidity and mortality, a lower risk of subsequent fractures, and are more likely to return to the same location they lived in before hospital admission.

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“…Patients with decreased pulmonary reserve are at risk for BCIS. If cementation is undertaken in these patients, it is important to make the anesthesia team aware of when the cement is being pressurized 51 . Lastly, elderly patients have a higher fat-to-marrow ratio, thus increasing the risk of fat embolism.…”

Section: Femoral Stem Fixation: Cemented Vs Uncementedmentioning

confidence: 99%

Recent advances in the treatment of hip fractures in the elderly

et al. 2016

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The treatment of hip fractures in the elderly represents a major public health priority and a source of ongoing debate among orthopaedic surgeons and anesthesiologists. Most of these injuries are treated with surgery in an expedient fashion. From the surgical perspective, there are certain special considerations in this population including osteoporosis, pre-existing arthritis, age, activity level, and overall health that contribute to the type of surgical fixation performed. Open reduction and internal fixation versus arthroplasty remain the two major categories of treatment. While the indications and treatment algorithms still remain controversial, the overall goal for these patients is early mobilization and prevention of morbidity and mortality. The use of preoperative, regional anesthesia has aided in this effort. The purpose of this review article is to examine the various treatment modalities for hip fractures in the elderly and discuss the most recent evidence in the face of a rapidly aging population.

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Safety guideline: reducing the risk from cemented hemiarthroplasty for hip fracture 2015

Cited by 85 publications

References 9 publications

Tight intra-operative blood pressure control versus standard care for patients undergoing hip fracture repair – Hip Fracture Intervention Study for Prevention of Hypotension (HIP-HOP) trial: study protocol for a randomised controlled trial

Tight intra-operative blood pressure control versus standard care for patients undergoing hip fracture repair – Hip Fracture Intervention Study for Prevention of Hypotension (HIP-HOP) trial: study protocol for a randomised controlled trial

Team Approach: Multidisciplinary Treatment of Hip Fractures in Elderly Patients

Recent advances in the treatment of hip fractures in the elderly

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