Abstract
Background
Hip fracture in the elderly is associated with significant morbidity and mortality. These patients often have serious co-morbidities, including cardiac conditions, and are at risk of developing perioperative decompensation. Heart failure represents a common and serious perioperative condition in hip fracture patients1. We conducted a quality improvement project to identify incidence of perioperative pulmonary oedema and the possible risk factors.
Method
Retrospective analysis of patients aged 60 years and older admitted with hip fracture over a one month period. Perioperative period was taken as time from admission to day 5 post surgery. Intravenous fluids administered pre-op, intra-op and for 5 days post-op were reviewed. Pulmonary oedema was diagnosed on clinical and radiological findings.
Results
50 patients admitted: 14 (28%) male; 36 (72%) female. Mean age: 82 years, 94% (47) admitted via emergency department. Comorbidities: 48% hypertension, 30% atrial fibrillation/flutter, 18% cardiac failure, 14% dementia. Pre-operative clinical review identified 14 (28%) patients as high risk for developing cardiac decompensation perioperatively. 57% (27/47) of patients admitted via accident and emergency received intravenous fluids pre-operatively. None of these patients had vital signs suggestive of hypovolaemia. Rate of fluid administration: 10/27 (37%) 1 litre over 4 hours, 5/27 (22%) 1 litre over 2 hours, 2/27 (7%) 1 litre over 1 hour. Intra-operatively 43 patients (86%) received intravenous fluids, 18 patients (36%) received ≥ 2 litres of fluid. 6 (12%) patients developed pulmonary oedema in the perioperative period
Conclusion
Fluid overload in our cohort may be an underestimate as many patients were anticipated to be at high risk of developing pulmonary oedema with consequent very careful fluid management and diuretic administration. Intravenous fluid administration requires careful assessment and monitoring in elderly hip fracture patients.
References
1. Michael W Cullen 1 , Rachel E Gullerud, Dirk R Larson et al J Hosp Med 2011 Nov;6(9):507-12.