240 Reviewing time-to-surgery for acute hip fractures in older adults to develop ‘SipTilSend’ policies

Abstract

Abstract Background Current international guidelines for pre-operative fluid fasting is 2 hours. Patients presenting with hip fractures often fast indeterminately from the midnight prior to day of surgery. Prolonged oral fluid deprivation is unpleasant for patients and is associated with patient discomfort, malaise, dissatisfaction, nausea and vomiting, dehydration and possibly delirium. Our aim was to review the times-to-surgery with a view of implementing ‘SipTilSend’. ‘SipTilSend’ aims to shorten pre-operative fluid deprivation by allowing patients to sip water or other clear fluids until they are sent to theatre. Methods Data of patients over the age of 65 admitted with a hip fracture collected as part of the Irish Hip Fracture Database over a five month period from December 2022 to April 2023 was analysed. This included age, time-to-surgery, reasons for delay in surgery as well as 4AT scores on day1 and day3. Results Of the 55 patients presenting with hip fracture, the average age was 79, with a mean time-to-surgery of 34.8 hrs. 83.6% of patients (n = 46) achieved time-to-surgery of <48 hours, with a mean of 25.2 hrs. The shortest time-to-surgery was 8.3 hrs, longest 46.9 hrs. 9 patients underwent surgery after 48 hours from time of presentation, five were delayed due to being on anticoagulants, two due to theatre overrun, one required a pacemaker check and one had experienced polytrauma. The incidence of delirium (4AT score > 4) was 14.5% (n = 8), the mean time-to-surgery for these patients was 32.9 hours. Conclusion Time to surgery for patients over the age of 65 presenting with acute hip fractures can be varied and extended. Despite efforts of proactive trauma list planning to improve fasting times, this effect in practice was small. Our plan is to implement ‘SipTilSend’ and perform a re-audit on the overall risk for aspiration and patient comfort.