Medical complications of surgery: an orthogeriatrician's perspective

Abstract

Hip fracture is one of the most common admission diagnoses in the UK. Fractured neck of femur can be classified as a ‘frailty’ presentation because of an average age of >80 years, a clear association with ‘pathological falls’, including syncope, and a high number of co-morbidities. The combination of traumatic injury, frailty and surgery presents significant challenges to the managing team and requires a multidisciplinary approach to reduce the risk of perioperative complications, most commonly postoperative delirium, sepsis, cardiac complications, stroke and metabolic disturbance. Close monitoring with geriatric co-management has been shown to reduce complications and resultant morbidity, length of stay and mortality. Many lessons learnt from the experience of managing these very challenging patients has been transferred to other frail patients undergoing surgery in perioperative geriatric services and major trauma.