Standard of care in most patients with hip fractures is surgery within the first 48 hours, which is driven by superior outcomes in mobility, hospital stay, thromboembolism risk, and pain control. A question arises, however, when a patient endures fracture in the setting of a pre-existing limited life expectancy. There is not a consensus, in the literature or in clinical practice, on the management of hip fractures in patients at end of life. The limited data that does exist on orthopedic surgery as a form of palliation focus primarily on survival and pain outcomes in nonoperative vs. operative groups. There is some support in the literature for orthopaedic surgical intervention for palliative care of fractures in patients with the potential for mobilization and/or pain management, even with poor prognosis.
It is important to recognize that while palliative surgery may be the best approach in terms of patient-centered decision making, the current system of quality reporting does not directly account for this situation, and surgeons and their institutions are penalized for mortality and complications, even when these are expected. Reform to quality reporting to accommodate palliative surgery would facilitate patient-centered care among providers.
Target population: OTA members