TY  - BOOK
AU  - Hussein, Z.
AU  - Ezihe-Ejiofor, J.A.
AU  - Ameerun, P.
AU  - Wright, D.
TI  - Short-term postoperative outcomes in hip fracture patients: are we failing the frail?
PY  - 2015///
N1  - NMUH Staff Publications; EMBASE; 70
N2  - <span style="font-size: 10pt;"><span style="color: #4a4a4a; font-family: Lato, "Helvetica Neue", Helvetica, Arial, sans-serif; text-decoration-color: initial;">Elderly patients undergoing major joint surgery report intense postoperative pain and are at risk of suboptimal analgesia [1]. Following the introduction of the Enhanced Recovery After Surgery (ERAS) program, elective total hip replacement (THR) patients have an effective multimodal approach to their postoperative pain management. However, there is little consensus as to what constitutes optimal postoperative analgesia in neck of femur fracture (NOFF) patients. This audit aimed to map the postoperative recovery profile of our NOFF patients and compare this with a cohort of elderly patients undergoing elective THR. Methods Between August and October 2014, we followed up patients > 60 years, undergoing elective THR or a repair of NOFF for 48 h postoperatively. We collected data on worst pain, least pain, nausea and drowsiness scores (0-10). We also collected data on secondary outcomes contributing to or affected by suboptimal analgesia such as time of first oral intake and time to mobilisation. Secondary outcome data from patients with an Abbreviated Mental Test Score (AMTS) < 7 were not included for comparison but analysed separately. Results We included 26 THR and 35 NOFF repair patients in the comparison. The average age of the NOFF group was 76 years (+/-12.3) while the THR group was 67 years (+/-10.5). Three techniques accounted for the anaesthetic choice in >80% of THR patients: 54% had GA and LA infiltration, 19% GA only and 15% had a spinal. In the NOFF group there was wide variation with 9 different combinations of anaesthetic technique. This wide variation was also evident in the choice of intra and postoperative analgesia. Patients in the NOFF group had higher worst pain scores on postoperative days 1 and 2, longer time to first oral intake and longer time to mobilise. Postoperative outcomes in THR vs NOFF patients Sixteen NOFF patients were cognitively impaired with AMTS of 2.7 (+/-2.4). Mean age in this group was 85 years (+/-2.9). Time to first oral intake was twice as long (12.5 h +/- 5) compared to THR or cognitively intact NOFF patients. We could not objectively quantify the pain levels in these patients as we chose to use a self reporting pain scoring system. All patients in this group were catheterised and in 93% of patients the catheter was still in situ after 48 h and none had mobilised by this time. (table present). Discussion Our cognitively intact NOFF patients had less favourable short term postoperative outcomes compared to a cohort of elderly THR patients. What was particularly shocking was the difference in the cognitively impaired NOFF group. Cognitively impaired patients are more likely to experience unnecearrily prolonged starvation, urinary catheterisation and delayed mobilisation. We are now addressing this by introducing a NOFF peri-operative pathway that incorporates nationally agreed standards of care. We are also moving to using a behavioural assessment of pain tool so this group is no longer excluded.</span> [Conference abstract]</span&gt
UR  - https://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.13224
ER  -