Commentary on “Relation Between Prefracture Characteristics and Perioperative Complications in the Elderly Adult Patient With Hip Fracture”

Hip fractures in elderly adults are associated with a staggeringly high short- and long-term mortality rate that cannot be explained by a fracture alone. Furthermore, the functional limitations of survivors can be pronounced. 1 Many issues, including preoperative medical evaluation, timing of surgery, perioperative management of chronic medical problems, deep venous thrombosis prophylaxis, pain, delirium, nutrition, fluid status, and urinary tract management, are essential for the optimal care of these patients. 2 Given the increased mortality rate associated with delay in surgery, timely medical optimization both before and after surgery is paramount, as illustrated in an analysis of surgical delay in patients with hip fracture. 3 To improve clinical outcomes for this vulnerable population of patients, two general approaches have been taken. The first is a comanagement model, with either hospitalists or geriatricians teamed with orthopedic surgeons. This model of care has been shown to improve care efficiency and to reduce length of stay without adversely affecting mortality or postoperative complications. 4,5 Although management of the above medical conditions by hospitalists/geriatricians presumably lead to better clinical efficacy and patient satisfaction, consistent reduction of mortality rate and morbidity has yet to be seen. The second approach is to identify prefracture characteristics and perioperative predictive risk factors for postoperative complications and mortality, which eventually will allow for selective triaging and targeted intervention. In their study, Brown et al took an important step in examining these characteristics and their results added to the growing list of predictive perioperative risk factors. 6