Too unfit not to have surgery: is non‐operative care for hip fracture patients a viable option?

AnaesthesiaEarly View Editorial Too unfit not to have surgery: is non-operative care for hip fracture patients a viable option? This article relates to: Epidemiology, patient outcome and complications after non-operative management of hip fracture: a systematic review James Winfield, Lynn McNicoll, Iain K. Moppett, Anaesthesia First Published online: August 25, 2025 Nicolai B. Foss, Corresponding Author Nicolai B. Foss [email protected] orcid.org/0000-0002-9376-3845 Department of Anaesthesiology, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark Correspondence to: Nicolai B. Foss Email: [email protected]Search for more papers by this authorSøren Overgaard, Søren Overgaard orcid.org/0000-0001-6829-4787 @Soren_Overgaard Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark Department of Orthopaedic Surgery and Traumatology, Copenhagen University Hospital Bispebjerg, Copenhagen, DenmarkSearch for more papers by this author Nicolai B. Foss, Corresponding Author Nicolai B. Foss [email protected] orcid.org/0000-0002-9376-3845 Department of Anaesthesiology, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark Correspondence to: Nicolai B. Foss Email: [email protected]Search for more papers by this authorSøren Overgaard, Søren Overgaard orcid.org/0000-0001-6829-4787 @Soren_Overgaard Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark Department of Orthopaedic Surgery and Traumatology, Copenhagen University Hospital Bispebjerg, Copenhagen, DenmarkSearch for more papers by this author First published: 26 August 2025 https://doi.org/10.1111/anae.16735 This editorial accompanies an article by Winfield et al., Anaesthesia 2025; https://doi.org/10.1111/anae.16732. Bluesky: @nicolaibangfoss.bsky.social? Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookxLinkedInRedditWechatBluesky References 1Griffiths R, Babu S, Dixon P, et al. Guideline for the management of hip fractures 2020. Anaesthesia 2021; 76: 225–237. https://doi.org/10.1111/anae.15291. 10.1111/anae.15291 CAS PubMed Web of Science® Google Scholar 2Stoneham M, Murray D, Foss N. Emergency surgery: the big three – abdominal aortic aneurysm, laparotomy and hip fracture. Anaesthesia 2014; 69(Suppl 1): 70–80. https://doi.org/10.1111/anae.12492. 10.1111/anae.12492 Google Scholar 3Vleeshouwers K, Beert J, Boonen A, et al. The effects of in-hospital orthogeriatric care on health-related quality of life: a systematic review and meta-analysis. Age Ageing 2025; 54: afaf106. https://doi.org/10.1093/ageing/afaf106. 10.1093/ageing/afaf106 Web of Science® Google Scholar 4Zhu R, Yang F, Li C, Zhu H, Lin L, Zhao X. Effect of enhanced recovery after surgery on the prognosis of patients with hip fractures: a systematic review and meta-analysis. J Trauma Nurs 2023; 30: 271–281. https://doi.org/10.1097/jtn.0000000000000741. 10.1097/jtn.0000000000000741 Web of Science® Google Scholar 5Wainwright TW, Gill M, McDonald DA, et al. Consensus statement for perioperative care in total hip replacement and total knee replacement surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations. Acta Orthop 2020; 91: 3–19. https://doi.org/10.1080/17453674.2019.1683790. 10.1080/17453674.2019.1683790 PubMed Web of Science® Google Scholar 6Johansen A, Viberg B. Nonoperative hip fracture care: how conservative should we be? Acta Orthop 2025; 96: 174–175. 10.2340/17453674.2025.43190 Google Scholar 7Rogmark C, Lynøe N. How to play the final chess match—or at least lose with dignity. Acta Orthop 2021; 92: 633–634. https://doi.org/10.1080/17453674.2021.1959159. 10.1080/17453674.2021.1959159 Web of Science® Google Scholar 8Xiang L, Singh M, McNicoll L, Moppett IK. Clinician perspectives on nonoperative management of hip fractures during COVID-19: an international survey. Bone Jt Open 2023; 4: 766–775. https://doi.org/10.1302/2633-1462.410.bjo-2023-0069.r1. 10.1302/2633-1462.410.BJO-2023-0069.R1 Google Scholar 9Winfield J, McNicoll L, Moppett IK. Epidemiology, patient outcome and complications after non-operative management of hip fracture: a systematic review. Anaesthesia 2025. https://doi.org/10.1111/anae.16732. 10.1111/anae.16732 Google Scholar 10Broughton KJ, Aldridge O, Pradhan S, Aitken RJ. The Perth emergency laparotomy audit. ANZ J Surg 2017; 87: 893–897. https://doi.org/10.1111/ans.14208. 10.1111/ans.14208 PubMed Web of Science® Google Scholar 11Al-Temimi MH, Griffee M, Enniss TM, et al. When is death inevitable after emergency laparotomy? Analysis of the American College of Surgeons National Surgical Quality Improvement Program Database. J Am Coll Surg 2012; 215: 503–511. https://doi.org/10.1016/j.jamcollsurg.2012.06.004. 10.1016/j.jamcollsurg.2012.06.004 PubMed Web of Science® Google Scholar 12Boss EF, Mehta N, Nagarajan N, et al. Shared decision making and choice for elective surgical care: a systematic review. Otolaryngol Head Neck Surg 2016; 154: 405–420. https://doi.org/10.1177/0194599815620558. 10.1177/0194599815620558 Web of Science® Google Scholar 13Kolh P, De Hert S, De Rango P. The concept of risk assessment and being unfit for surgery. Eur J Vasc Endovasc Surg 2016; 51: 857–866. https://doi.org/10.1016/j.ejvs.2016.02.004. 10.1016/j.ejvs.2016.02.004 CAS Web of Science® Google Scholar 14Poulton T, Murray D, National Emergency Laparotomy Audit (NELA) project team. Pre-optimisation of patients undergoing emergency laparotomy: a review of best practice. Anaesthesia 2019; 74(Suppl 1): 100–107. https://doi.org/10.1111/anae.14514. 10.1111/anae.14514 Google Scholar 15Johansen A, Tsang C, Boulton C, Wakeman R, Moppett I. Understanding mortality rates after hip fracture repair using ASA physical status in the National Hip Fracture Database. Anaesthesia 2017; 72: 961–966. https://doi.org/10.1111/anae.13908. 10.1111/anae.13908 CAS PubMed Web of Science® Google Scholar 16Zeelenberg ML, Loggers SAI, Joosse P, et al. Satisfaction and quality of dying with nonoperative end-of-life care for hospitalized and non-hospitalized frail older patients with (suspected) hip fractures: a combined cohort study. Acta Orthop 2025; 96: 167–173. https://doi.org/10.2340/17453674.2025.42998. 10.2340/17453674.2025.42998 Web of Science® Google Scholar 17Morrison RS, Magaziner J, McLaughlin MA, et al. The impact of post-operative pain on outcomes following hip fracture. Pain 2003; 103: 303–311. https://doi.org/10.1016/s0304-3959(02)00458-x. 10.1016/S0304-3959(02)00458-X Web of Science® Google Scholar 18Foss NB, Kristensen MT, Palm H, Kehlet H. Postoperative pain after hip fracture is procedure specific. Br J Anaesth 2009; 102: 111–116. https://doi.org/10.1093/bja/aen345. 10.1093/bja/aen345 CAS Web of Science® Google Scholar 19Foss NB, Kehlet H. Mortality analysis in hip fracture patients: implications for design of future outcome trials. Br J Anaesth 2005; 94: 24–29. https://doi.org/10.1093/bja/aei010. 10.1093/bja/aei010 CAS Web of Science® Google Scholar 20Griffiths F, Mason V, Boardman F, et al. Evaluating recovery following hip fracture: a qualitative interview study of what is important to patients. BMJ Open 2015; 5: e005406. https://doi.org/10.1136/bmjopen-2014-005406. 10.1136/bmjopen-2014-005406 Web of Science® Google Scholar 21Wijnen HH, Schmitz PP, Es-Safraouy H, Roovers LA, Taekema DG, Van Susante JLC. Nonoperative management of hip fractures in very frail elderly patients may lead to a predictable short survival as part of advance care planning. Acta Orthop 2021; 92: 728–732. https://doi.org/10.1080/17453674.2021.1959155. 10.1080/17453674.2021.1959155 Web of Science® Google Scholar 22Onwuteaka-Philipsen BD, Brinkman-Stoppelenburg A, Gwen CP, De Jong-Krul JF, Van Delden JJM, Van Der Heide A. Trends in end-of-life practices before and after the enactment of the euthanasia law in the Netherlands from 1990 to 2010: a repeated cross-sectional survey. Lancet 2012; 380: 908–915. https://doi.org/10.1016/s0140-6736(12)61034-4. 10.1016/S0140-6736(12)61034-4 Web of Science® Google Scholar 23Florijn BW. Extending euthanasia to those 'tired of living' in the Netherlands could jeopardize a well-functioning practice of physicians' assessment of a patient's request for death. Health Policy 2018; 122: 315–319. https://doi.org/10.1016/j.healthpol.2018.01.007. 10.1016/j.healthpol.2018.01.007 Web of Science® Google Scholar Early ViewOnline Version of Record before inclusion in an issue ReferencesRelatedInformation