The Role of Physiologic Monitoring in Patients with Fractures of the Hip

Mortality rates for elderly patients with hip fractures have been reported to be as high as 37%. This study evaluated 70 patients of whom 35 were evaluated preoperatively by conventional diagnostic means, and 35 in whom hemodynamic, respiratory, and metabolic status was assessed using a Swan-Ganz balloon-tipped catheter. The derived variables were then calculated by a minicomputer and automatically plotted on a printed graphic display in a bar graph format. This diagnostic modality permitted appreciation of occult physiologic aberrations not detected by conventional methods, enabling correction of these abnormalities preoperatively and postoperatively. The study demonstrated a mortality rate of 2.9% in the monitored group compared to a 29% mortality in the nonmonitored group. The intrinsic assumption that patients should undergo surgery within 24 hours (3) was also modified. The appropriate time for surgery should be accurately determined and chosen on the basis of optimal physiologic balance.