Preoperative evaluation of acute hip fracture

Preoperative condition or organ systemInterventions and comments
FallEvaluate the cause of the fall, including cardiac and neurologic syncopal episodes. Correct complications from the fall such as rhabdomyolysis, dehydration, and acute renal failure.
DiabetesPatients 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, thrombocytopeniaEvaluate anemia with a hemoglobin below 8 g/dL and thrombocytopenia with a platelet count < 100 × 109/L, and correct as needed.
Anticoagulation before admissionEvaluate 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.
RespiratoryBronchospasm 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.
RenalDiscontinue angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers preoperatively, and provide adequate hydration with isotonic fluid.
CardiovascularHigh-risk cardiac conditions should not disqualify surgery. Emphasis is on shared decision-making with the patient and family.