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Table 1 Main interventions of enhanced recovery pathway unit for hip fracture patients

From: Effect of goal-directed haemodynamic therapy guided by non-invasive monitoring on perioperative complications in elderly hip fracture patients within an enhanced recovery pathway

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.
  1. a Surgery was postponed for 4 days in patients who, at admission, had been administered acetylsalicylic acid >100 mg, triflusal >300 mg or clopidrogel/ticlopidine. Surgery was postponed in patients who were on OAC treatment at admission, until INR < 1.5
  2. b 2 g cefazolin in intramedullary nail surgery in 100 ml saline, or cefuroxime and teicoplanin in prosthesis surgery (in a total of 200 ml saline)