Operative and non-operative management of people with hip fracture: A modified-Delphi study to develop an international consensus

OBJECTIVE: To develop a series of consensus statements regarding the operative and non-operative management of hip fracture patients. METHOD: A two-round modified-Delphi study was used to obtain consensus on statements for the the operative and non-operative management of hip fracture patients. Panel members rated the importance of each statement to guide the decision to operatively or non-operatively treat hip fracture patients. High consensus was defined as agreement of ≥ 70% and moderate consensus 50-69% between participants. RESULTS: There were 67 round 1 and 55 round 2 panellists. Panellists were working across 17 countries and commonly were anaesthetists (30%), orthopaedic or trauma surgeons (28%), or geriatricians (27%). Just less than one-quarter of panellists (24%) indicated the facility they predominately worked in had a protocol for the non-operative management of hip fracture patients. At the conclusion of the modified-Delphi study, 14 (93%) statements achieved high consensus and one (7%) statement moderate consensus. CONCLUSION: The consensus statements are intended to support shared decision-making regarding non-operative hip fracture care and to promote a more consistent approach to the management of older adults with hip fracture at the end of life. Ultimately, the decision for operative or non-operative management should be made based on each patient's individual circumstances.