#35900 POMAHR – perioperative management of patient with hip fracture in centro hospitalar universitário lisboa norte (CHULN)

Abstract

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Background and Aims

Proximal femoral fractures (PFF) are an important public health problem in industrialized societies, affecting older, mainly female, patients who are more likely to suffer from osteoporosis. PFF are associated with increased morbidity and functional impairment with a negative impact on patient’s quality of life. Nearly always, PFF requires hospitalisation, permanently disables 50% of patients and a 26% one-year mortality rate, in elderly patients, has been described. The National Institute for Health and Care Excellence (NICE) recommends that patients with a hip fracture should have surgery within 36 hours of admission to hospital. In CHULN, we elaborated a protocol that allows patients to have surgical intervention within 36-48 hours, creating a multidisciplinary patient-centered approach, optimizing their clinical status and enhancing their recovery.

Methods

POMAHR has the following principles

1-preoperative patient medical optimization according to clinical protocols 2-early pain control with regional anesthesia 3-nutritional protocols with liquid intake up to 2h before surgery and protein reinforcement 4-surgical intervention within 36-48h 5- perform chemical neurolysis to control pain in patients who lack surgical indication 6-early rehabilitation since day1

Results

Patients with PFF are mainly elderly, often with several comorbidities, needing a multidisciplinary approach in addition to surgery within 48 hours. We hope to reduce perioperative complications, reducing time of hospitalisation and mortality thus enhancing recovery and previous functional status.

Conclusions

The implementation of this protocol in our center, promotes a multidisciplinary approach, a prompt intervention and a continuous clinical monitoring of patients with PFF, from admission to hospital discharge. These factors are key to successful patients’ treatment.