Intraoperative management of geriatric hip fractures in China: A survey

Objective To investigate the current perioperative management of geriatric hip fractures in China. Methods The survey was performed between 15th to 21st of November, 2017. An electric questionnaire was delivered to the orthopedic surgeons attending the 12th International Congress of Chinese Orthopedic Association (COA) and the orthopedic fellows attending grand round at Department of Orthopaedic Trauma, Beijing Jishuitan Hospital. The questionnaire addressed the current perioperative management of geriatric hip fractures (≥65 years) at the departments where the participants worked, covering preoperative examination and preparation, postoperative rehabilitation and multidisciplinary collaboration. Results 171 valid questionnaires were collected for this study. Of the 171 orthopedic surgeons from 28 provinces in China, 106 (62.0%) came from a tertiary hospital and 65 (38.0%) from a secondary hospital. In 74.3% (127/171) of the hospitals, more than 100 geriatric hip fractures were treated annually. 63.2% (108/171) of the hospitals treated 100 to 500 cases annually, 5.9% (10/171) 500 to 1,000 cases and 5.3% (9/171) more than 1,000 cases. Multidisciplinary collaboration was not established in most hospitals (71.9%, 123/171) for geriatric hip fractures. Pulmonary function test (61.4%, 105/171), Holter (38.0%, 65/171) and ambulatory blood pressure monitoring (53.8%, 92/171) were indicated as routine preoperative investigations. In 56.3% (96/171) of the hospitals, traction was performed before operation. In 80.1% (137/171) of the hospitals, the interval between admission to surgery was more than 48h for the patients. In 36.3% (62/171) of the hospitals, patients were allowed to ambulate within one week after surgery. In 4.1% (7/171) of the hospitals, patients were allowed full weight-bearing within one week after surgery. Conclusion Significant gaps exist in perioperative management of geriatric hip fractures between current practice in China and worldwide guidelines and consensus. Key words: Hip fractures; Aged; Epidemiology; Surgical treatment