• Hip fractures
• Pre-op considerations
• Elderly
• Polypharmacy
• High risk
• Blood loss variable
• Consider fluid balance and catheterisation
• Senior anaesthetic and surgical input
• Delays of 48 hrs or more have a poorer outcome
• Intra-op optimisation
• Consideration of ODM
• Consider arterial line
• Post-op care
• Fluid management
• Supplemental O₂ for 72 hrs
• Avoid NSAIDs
• Mobilise early
• Nutrition
• Operative management
• GA
• Lower levels of post-op hypotension
• Higher blood loss but not increase in transfusion requirement
• Lower sats post-op
• Higher rate of MI?
• ? Increased POCD
• CNB should be delayed for >12 hrs post-LMWH
• Regional
• Lower blood loss
• Lower incidence of DVT & PE
• Reduced operative time
• Possibly higher CVA rate
• Regional has lower mortality at 1/12 but not 3/12
• Local nerve block
• Reduces opiate consumption
• Combination
• Little evidence of long term mortality benefit