Preoperative fluid management of the older adult patient with hip fracture
Background While recommendations about the preoperative fluid management of the older adult hip fracture patient have been produced the evidence relating to postoperative outcomes is scant. Aim The aim of this study is, therefore, to explore the relationships between preoperative fluid management (PFM) - defined as timing to start of fluids (oral or intravenous) after admission, preoperative oral fluid rate, and timing of last preoperative oral fluids – and postoperative outcomes - defined as change in renal function (creatinine and GFR), new reported postoperative confusion, timing of discontinuation of postoperative intravenous fluids (IV), and length of stay (LOS). Method This observational study looked at 100 consecutive older adult patients admitted to a tertiary New Zealand hospital with traumatic hip fracture between March and September, 2012. Data was gathered regarding cohort demographics and in hospital events, including surgical details, alongside PFM and postoperative outcomes. Descriptive statistics, linear regression, independent t-tests, tests of equality, and multiple logistic regression were utilised to ascertain relationships between variables. Results Characteristics of the perioperative journey of 100 consecutive patients, with mean age of 85.2 yr (SD 6.6) and predominantly female (70%), presenting to CCDHB with a fragility hip fracture were itemised. High rates of co-morbidities were observed in this group, with 92% of patients having cardiac, pulmonary, vascular or renal co-morbidities, but with a mortality rate (2%) much lower than the literature would suggest might be expected. There was no substantiated statistically significant relationships observed between preoperative fluid management in this cohort and postoperative outcomes, but this may reflect limited power in this study. Conclusion These results provide useful data for planning services with regards management of the older adult hip fracture patient at CCDHB. In addition, the study has highlighted a number of clinical guidelines that might be more effectively promoted.