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Audit of perioperative management of patients with fracture neck of femur

Authors:

Nilmini Wijesuriya,

LK
About Nilmini
Consultant Anaesthetist, Colombo North Teaching Hospital, Ragama
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Mihiri Dissanayake

LK
About Mihiri
Regisitrar in Anaesthesiology, National Hospital of Sri Lanka.
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Abstract

Introduction Fracture neck of femur is the commonest reason for surgery in sick, elderly patients. For many of them, hip fracture is said to be the beginning of the end of their journey of life. Early surgery may lead to better outcomes. The aim of this audit was to study current practice and adherence to safety guidelines published by the AAGBI (Association of Anaesthetists of Great Britain and Ireland) UK, as no local guidelines are available at present.

Method A retrospective audit was carried out at Colombo North Teaching Hospital Ragama in 10 wards on all patients above 60 years (n=41) and had surgery for fracture neck of femur from 15thJanuary to 15th June 2014. Data were extracted from patient records using a data collection form.

Results Mean age of the population was 75.8 years and72.9% were females and 27% were males. Only four patients (11%) had surgery within the recommended period of 48 hours after admission. 50% of patients had surgery only after 7-8 days. Delays were compounded by late admission to hospital following injury. One patient died of a probable acute coronary event or pulmonary embolism. Lack of close monitoring of these patients due to inadequate intensive care beds, complicates the postoperative management. None of these patients received thrombo-prophylaxis despite current guidelines.

Conclusions and Recommendations Adherence to standard practice guidelines for management of patients with fracture neck of femur is found to be unsatisfactory at CNTH, Ragama. The delays are due to late admission, late referral to orthopaedic team and anaesthetists and lack of dedicated theatre time and intensive care beds. Thromboprophylaxis in this high risk category of patients is not carried out. There is an urgent need to address these issues and plan perioperative management of these patients according to available standard practice guidelines.

DOI: http://dx.doi.org/10.4038/slja.v23i1.7778

How to Cite: Wijesuriya, N. & Dissanayake, M., (2015). Audit of perioperative management of patients with fracture neck of femur. Sri Lankan Journal of Anaesthesiology. 23(1), pp.17–21. DOI: http://doi.org/10.4038/slja.v23i1.7778
Published on 11 Jan 2015.
Peer Reviewed

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