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Preoperative Risk Factors for Complications Following Hip Fracture Surgery

Purpose: To evaluate an older adult with a hip fracture for risk factors associated with complications after hip surgery based on the study of McLaughlin et al.

Description

McLaughlin et al identified preoperative abnormalities in a patient with hip fracture that are associated with postoperative complications. These can help identify a patient who should have problems corrected prior to surgery. The authors are from Mount Sinai Hospital in New York, Bronx VA Medical Center. University of Arkansas, State University of New York, University of Albany and the Hospital for Joint Diseases in New York.


Patient selection: older adult with hip fracture

 

Parameters:

(1) blood pressure in mm Hg (systolic or diastolic)

(2) cardiac rate and rhythm (heart rate or tachyarrhythmia or heart block)

(3) infection and/or pneumonia (temperature with or without signs of pneumonia)

(4) chest pain and/or cardiac ischemia

(5) congestive heart failure (CHF)

(6) respiratory function (pulse oximetry or PaO2 to PaCO2)

(7) international normalized ratio for the PT (INR)

(8) electrolyte levels (sodium or potassium or bicarbonate)

(9) glucose

(10) renal function (BUN or creatinine)

(11) anemia (hemoglobin)

 

Parameter

Major Problem

Minor Problem

systolic BP

<= 90 mm Hg

>= 181

diastolic BP

NA

>= 111 mm Hg

heart rate

<= 45 beats per minute

46 to 50 beats per minute

tachyarrhythmia

AF or SVT >= 121, ventricular tachycardia

AT or SVT 101-120; sinus tachycardia >= 121

heart block

third degree

NA

temperature

< 35°C; >= 38.5°C AND signs of pneumonia

>= 38.5°C OR signs of pneumonia (not major)

cardiac ischemia or chest pain

AMI on ECG; chest pain with abnormal ECG

chest pain with normal ECG

CHF

pulmonary edema on chest X-ray; CHF on X-ray AND dyspnea or abnormal exam

(dyspnea OR pulmonary rales OR S3) AND normal chest X-ray;

pulse oximetry

< 90%

NA

PaO2

< 60 mm Hg

NA

PaCO2

>= 55 mm Hg

47 to 54 m Hg

INR

> 1.6

1.4 to 1.6

sodium

<= 125 or > 155 mmol/L

126 to 128 or 151 to 155

potassium

< 2.5 or > 6.1 mmol/L

2.5 to 2.9 or 5.6 to 6.0

bicarbonate

< 18 or > 36 mmol/L

18 - 19 or 35 - 36 mmol/L

glucose

> 600 mg/dL

451 to 600 mg/dL

BUN

> 50 mg/dL

41 to 50 mg/dL

creatinine

>= 2.6 mg/dL without history of end stage renal disease

2.1 to 2.5 without history of end stage renal disease

hemoglobin

<= 7.5 g/dL

7.6 to 8.0 g/dL

 

where:

• An abnormal ECG was defined as an ST depression or elevation. Biochemical markers of myocardial damage (troponin) might also be used.

• Second degree heart block might be added as a minor problem.

 

A parameter was considered abnormal if >= 1 of its components was abnormal.

 

total number of major abnormal parameters =

= SUM(number of parameters with one or more major problems in components)

 

Interpretation:

• minimum number of major abnormal parameters: 0

• maximum number of major abnormal parameters: 11

• The risk for complications was associated with > 1 major abnormality OR failure to correct major abnormalities prior to surgery.

• A patient with minor abnormalities only can proceed to surgery without correction.


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Specialty

Objective

ICD-10