Anaesthesia for fractured neck of femur

In the UK, 70,000 patients per year fracture their hips and the annual incidence is rising. There is an inevitable hospital mortality rate of 4–6% associated primarily with carcinomatosis. The 30% mortality rate at 1 year has not improved significantly over 25 years. The evidence base for best practice is weak and leads to conflicting conclusions. Many aspects of care advocated in guidelines are determined by consensus opinion. Early anaesthesia and surgery are championed but should not be rigidly offered at the expense of neglecting investigations such as echocardiography to identify significant aortic stenosis or the acute treatment of hypovolaemia, dysrhythmias, hypertension, cardiac ischaemia, cardiac failure, pulmonary insufficiency and poorly controlled diabetes. Anaesthesia should be tailored to each individual patient’s needs. Regional anaesthesia has only marginal advantages compared with general anaesthesia and is contraindicated if coagulation is abnormal. The closer involvement of anaesthetists in the management of resuscitation, perioperative fluid balance, postoperative pain relief and postoperative nutrition may improve outcome. Mortality rates vary between hospitals and within hospitals year by year. Regular departmental audit is advised to identify local areas of good or deficient practice.