Reducing morbidity and mortality in the hip fracture patient group

A review of the literature was undertaken to determine which amenable factors could be identified that would potentially improve the morbidity or mortality after hip fracture. Only two factors were identified that have been reported to be associated with a reduction in mortality, these were early surgery and experience of the surgeon. Other factors identified that may potentially reduce morbidity were early surgery, experience of the surgeon, and peri-operative antibiotics. Four interventions were identified that may reduce mortality or morbidity: nerve blocks, nutritional support, pharmacological thromboembolic prophylaxis, and mechanical intermittent pneumatic compression. A number of other factors were identified for which it remains uncertain if they will reduce mortality or morbidity: Pre-operative assessment, B blockers, blood transfusion, anti-embolism stockings, choice of surgical implant, cardiac output monitoring during surgery, choice of anaesthesia, prevention of intra-operative hypotension, anabolic steroids, multidisciplinary care, and rehabilitation. Continuing research is required to define which interventions are clearly effective and to further identify their potential adverse effects.