title: A prospective review of hip fracture subtypes, surgical procedure, cognitive status, and analgesia use across 4 Australian hospitals.
abstract: OBJECTIVE
  To correlate analgesia use among patients with hip fracture requiring surgery with hip fracture subtype, cognitive status, and type of surgery in the postacute period.
  
  
  METHODS
  Prospective review of patients with hip fractures requiring surgical intervention. A total of 415 patients (mean age: 81.2 ± 9.1 years, 74.3% women) presented with 195 subcapital fractures (39 undisplaced, 156 displaced) and 220 trochanteric fractures (136 stable, 84 unstable) requiring surgery.
  
  
  METHODS
  Inpatient orthopedic units in 4 Australian hospitals.
  
  
  METHODS
  The primary outcome measures were mean analgesia usage (oral morphine equivalent) for 4 defined time intervals and total amount 36 hours following surgery.
  
  
  RESULTS
  Patients with subtrochanteric fractures required more analgesia compared with displaced-subcapital, undisplaced-subcapital, basicervical, stable-pertrochanteric, and unstable-pertrochanteric fractures in the 24 to 36 hours following operation (24.7 vs 11.3 vs 8.8 vs 12.1 vs 7.6 vs 9.7, P = .001). Total analgesia requirements were higher in patients treated with an intramedullary nail, increasing by 1.3- to 3.3-fold in the 36 hours postsurgery. Patients with cognitive impairment utilized markedly less analgesia at all time periods measured. At 24 to 36 hours, higher levels of analgesia were noted in patients with higher premorbid level of mobility (P = .015) and activities of daily living function (P = .007).
  
  
  CONCLUSIONS
  Important differences in utilization of analgesia following hip fracture across readily defined clinical groups exist. Proactive pain management for those with cognitive impairment, certain hip fracture subtypes, and surgical procedures may enable early functional mobility and other activities.
authors.affiliation: Department of Geriatric Medicine, Northern Sydney Central Coast Area Health Service, Gosford Hospital, NSW, Australia ; Department of General Medicine, Mater Hospital, Sydney, NSW, Australia ; Rehabilitation Studies Unit, Sydney Medical School, University of Sydney, NSW, Australia.
authors.forename: Jenson C S
authors.initials: JC
authors.lastname: Mak
authors.forename: Ihab
authors.initials: I
authors.lastname: Lattouf
authors.forename: Alexei
authors.initials: A
authors.lastname: Narushevich
authors.forename: Charles
authors.initials: C
authors.lastname: Lai
authors.forename: Fintan
authors.initials: F
authors.lastname: O'Rourke
authors.forename: Qing
authors.initials: Q
authors.lastname: Shen
authors.forename: Daniel K Y
authors.initials: DK
authors.lastname: Chan
authors.forename: Ian D
authors.initials: ID
authors.lastname: Cameron
keywords: fragility fractures; geriatric medicine; geriatric trauma; physical medicine and rehabilitation; trauma surgery