Abstract
Introduction
The patients most often admitted with a hip fracture are older adults, many of whom are frail. The Scottish Hip Fracture Standards recommend that all patients have fluid assessment and are mobilised by the end of day 1 post operatively. We set out to look to see which patients are most at risk of acute kidney injury (AKI) and orthostatic hypotension (OH) post operatively and whether this was linked to the prescription of iv fluids (IVF).
Method
All online notes of patients admitted with a hip fracture in the months of July and November 2022 were reviewed. Notes were reviewed for type of anaesthesia (General Anaesthetic or spinal), frailty score (using Rockwood), presence of AKI on days 1-3 post operatively (as determined by looking at lab results), and presence of orthostatic hypotension on days 1-3 post operatively (as documented in physiotherapy notes).
Results
There were 120 patients audited (July: 59; November: 61). 39 patients had IVF prescribed post operatively, 15 developed orthostatic hypotension and 20 developed an AKI. The frailest patients (Rockwood 6/7) were most likely to be prescribed fluids post-operatively (25/52) however had the highest rate of AKI (12/52). Moderately frail patients (Rockwood 4/5) were less likely to be prescribed IVF (8/42) and most likely to develop orthostatic hypotension (9/42) even compared with the frailest patients (3/52). This did not differ by operation type as the same proportion received IV fluids with a spinal (11/30) or general anaesthetic (28/86). Antihypertensives were not linked to AKI but were to OH.
Conclusion
Moderately frail patients are the group that appear most likely to develop post operative orthostatic hypotension but are not prescribed post operative fluids as frequently as the most frail. This may be leading to increased risk of orthostatic hypotension and thereby delay rehabilitation in a vulnerable group.