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Guideline for the management of #HipFractures from @AAGBI Out for consultation: https://anaesthetists.org/Portals/0/PDFs/Guidelines%20PDFs/guidelines%20for%20the%20management%20of%20hip%20fractures.pdf?ver=2020-07-09-164056-413 What do people think? Edited highlights to follow...
Why new guidance for #HipFracture now? Basically - things move on, new data emerge, guidance should never stand still.
The fundamental principles of #HipFracture haven't changed but are well described in the @FF_Network consensus statement. Right people, clear standards, processes and feedback on outcomes.
So what's in the new guidance for #HipFracture? First up, the old chestnut of spinal versus GA. Lots of strong opinions, but few hard data to recommend one as clearly better than the other. Doing both well is probably more important.
#HipFracture is painful - before and after surgery, especially on movement. IMHO there is no perfect approach but having a sensible plan that is audited and reviewed is a good start. Single shot nerve blocks, paracetamol.
Perioperative care of an older person with #HipFracture includes those with significant frailty and co-morbidities. Careful, properly documented, realistic discussions about peoples' wishes and best interests are important. Some data here https://onlinelibrary.wiley.com/doi/full/10.1111/anae.13908
Anaemia is common and associated with worse outcome after #HipFracture. What to do about it is less clear cut. The Working Party has recommended 90g/L for frailer patients. What do others think?
Another bone of contention - the pre-op echo in #HipFracture? Again lots of opinions on the utility or otherwise. Guidance is clear on not delaying to get it. But are there patients where it should still be done - changing the system to avoid delay?
Just when we thought we had anticoagulation sorted, along came the DOACs! Tricky balance in #HipFracture between waiting and the need to operate. Pragmatic guidance here. Know when last dose taken, surgery at 24 hours for most on the Xa inhibitors (Xabans).
Personal comment on guidance and #HipFractures. First, most hip fracture care takes places in DGHs. So, the guidance has to work in that bedrock of NHS care. If it doesn't then something has to change...
Personal comment on guidance and #HipFractures. Second, they will never be perfect, nor apply to every circumstance. I strongly believe care is better when it is delivered in a consistent way, but there will be times when professionals can justify doing something different...
Personal comment on guidance and #HipFractures. Third, it's really important to get diversity of opinion on the guidance. Hence the thread and request for feedback. Just because I have written stuff doesn't mean I (or the rest of the working party
) am right.
) am right.
