Preoperative optimization and risk assessment.
Because most older adults with hip fractures require urgent surgical intervention, the preoperative medical evaluation focuses on the exclusion of the small number of contraindications to surgery, and rapid optimization of patients for operative repair. Although many geriatric fracture patients have significant chronic medical comorbidities, most patients can be safely stabilized for surgery with medical and orthopedic comanagement by anticipating a small number of common physiologic responses and perioperative complications. In addition to estimating perioperative risk, the team should focus on intravascular volume restoration, pain control, and avoidance of perioperative hypotension.
Division of Geriatrics, Highland Hospital, University of Rochester School of Medicine, 1000 South Avenue, Box 58, Rochester, NY 14610, USA. Electronic address: Joseph_Nicholas@urmc.rochester.edu.
Joseph A
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Nicholas
D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D016330:Frail Elderly; D015577:Geriatric Assessment / Q000379:methods; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D011183:Postoperative Complications / Q000517:prevention & control; D011300:Preoperative Care; D018570:Risk Assessment / Q000379:methods
Cardiovascular disease; Geriatric fracture management; Preoperative care; Preoperative risk assessment