Table 1 Main interventions of enhanced recovery pathway unit for hip fracture patients
Preoperative period | Intraoperative period | Postoperative period |
|---|---|---|
-Specialized hip fracture ward - Internist support - Assessment by anaesthesiologist - Nursing aids - Intravenous fluids - Monitor oxygen saturation/8 h. Oxygen therapy when < 92% and maintenance until 48 h after surgery - Pain control: avoiding opioids if possible - Carbohydrate loading until 2 h before surgery. - Protocol for patients who received antiplatelet drugs or oral anticoagulants on admission.a - Prioritize surgery within 48 h on admission in patients with medical stable condition. | - Prevention of intraoperative hypothermia - Intraoperative nausea and vomiting prophylaxis - Prophylactic antibiotic 30 min before surgical incision b - Avoid intrathecal opioids - Performance of peripheral nerve blocks | - Specialized hip fracture ward - Internist support - Nursing aids - Postoperative fluids should be stopped when possible, in favour of early oral intake. - Monitor oxygen saturation/8 h. Oxygen therapy when < 92% and maintenance until 48 h after surgery - Optimal postoperative analgesia, preferably with intraoperative peripheral nerve blocks and NSAIDs - Deep vein thrombosis prevention - Early respiratory physiotherapy - Early and standardized mobilization 24h after surgery. - Early urinary catheter removal |
Perioperative interventions | ||
- Gastric ulcer prophylaxis iv/24 h. - To avoid using opioids and/or benzodiazepines. - Screening and treatment when appropriate of urinary infection - Bladder catheterisation only in case of incontinency or when needing to monitor renal and/or cardiac function. - Treatment protocol for anaemia when haemoglobin was < 13 g/dl on admission. Transfusion was administered if haemoglobin level was < 8 g/dl and to patients with cardiorespiratory disease and/or haemodynamic instability when haemoglobin level was < 10 g/dl. | ||