Delay to surgery after hip fracture is associated with more pressure injury, delirium, pneumonia and death. NICE advises surgery on the day of, or the day after, admission, and correcting reversible problems in parallel rather than in sequence.
Anticoagulation, anaemia or a borderline echocardiogram are common causes of delay that can usually be managed without postponing theatre for days.
- Aim for surgery on the day of admission or the next day for every medically fit hip fracture patient.
- Give a fascia iliaca or femoral nerve block in the emergency department for pain.
- Correct anaemia, fluid status and electrolytes while theatre is arranged, not before booking it.
- Involve an orthogeriatrician from admission to manage medical issues and delirium risk.
Why it matters
Delay is the modifiable factor most consistently linked to worse outcomes after hip fracture.
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