Preoperative evaluation of acute hip fracture
| Preoperative condition or organ system | Interventions and comments |
|---|---|
| Fall | Evaluate the cause of the fall, including cardiac and neurologic syncopal episodes. Correct complications from the fall such as rhabdomyolysis, dehydration, and acute renal failure. |
| Diabetes | Patients with severe hyperglycemia (glucose levels > 400 mg/dL), ketoacidosis, or on an insulin pump: treat with an insulin infusion preoperatively with a target glucose level of 140–180 mg/dL. Patients with glucose levels > 180 mg/dL: the recommended total daily dose of insulin is 0.1–0.15 U/kg, given mainly as basal insulin, with correctional insulin coverage for glucose levels > 180 mg/dL before meals and at bedtime. |
| Anemia, thrombocytopenia | Evaluate anemia with a hemoglobin below 8 g/dL and thrombocytopenia with a platelet count < 100 × 109/L, and correct as needed. |
| Anticoagulation before admission | Evaluate an international normalized ratio (INR) > 1.5 and correct if needed. It is not necessary to have a normal INR or partial thromboplastin time before surgery. Assess continuation or reversal of anticoagulants. |
| Respiratory | Bronchospasm and hypoxemia require evaluation. For a patient with known asthma or chronic obstructive pulmonary disease, an exacerbation identified on preoperative evaluation may require acute bronchodilator therapy and consideration for surgical delay. Consider spinal anesthesia. |
| Renal | Discontinue angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers preoperatively, and provide adequate hydration with isotonic fluid. |
| Cardiovascular | High-risk cardiac conditions should not disqualify surgery. Emphasis is on shared decision-making with the patient and family. |