Geriatric Clinical Trial
Official title:
The PAGET Survey : Pre-operative Assessment for GEriatric Trauma Patients
Hip fracture is the second indication of surgical management elderly patients. It remains
linked with a one-year mortality of 20%-25% according to diiferent governmental agencies, and
the incidence reaches 30% for those over 80 years old.
The factors recognized and found to be most correlated with the survival / mortality ratio of
patients are age, sex, intervention time, and prior health status.
The aim of a preoperative clinical evaluation is to estimate the benefit-risk balance of
different clinical and technical managements and to prepare the postoperative patient
outcome. During the last decade, management of hip fracture has improved mainly due to the
different recommendations for a multidisciplinary management of perioperative procedures.
However, none of them have yet highlighted FOCUS echocardiography as a "routine" examination
of the preoperative evaluation as in most noncardiac surgeries.
The objective of this study is to evaluate the preoperative management of these patients:
Clinical and biological evaluation, and to analyze the place that would have the FOCUS
preoperative echocardiography in the choice of the anesthesia technique resulting from the
patient evaluation.That study in a pre-requisite study to evaluate the incidence of FOCUS
echocardiography realized by anesthesiologists in the preoperative period in order to define
patient's outcome and anesthetic management.
The question is whether the pre-operative routine preoperative echographic evaluation would
allow the correction or optimization of any comorbiditie, and / or lead to the modification
of the anesthetic management of the patients. Feasibility studies have recently focused on
the issue of ultrasound targeted at the patient's bedside. Thus, echocardiography data may
have implications for anesthetic but also surgical management.
With the advent of ultraportable ultrasound machines, the limit to routine preoperative
bedside use of the ultrasound tool appears to be resolved. The use of point-of-care
ultrasounds has proven useful in the management of critical patients in emergency and
intensive care units and is recommended in many countries.
Tthe investigators first want to assess the preoperative assessment of elderly and fragile
patients admitted urgently for hip surgery. The investigators are setting up a multicenter
observational questionnaire for consecutive patients. An electronic questionnaire is
distributed via SurveyMonkey to various university hospitals, general hospitals and private
institutions in France. The objective of this study is to evaluate the preoperative
management of these patients: Clinical, biological evaluation, and analyze the current daily
practice regarding the place of POC ultrasound preoperatively; the second question is to know
if the choice of the anesthesia technique results from the patient's assessment.
The investigators hope to have a reliable survey of current practices on a group of 500
consecutive patients and then to determine with greater accuracy the first expected real
hypothesis for a future prospective randomized multicenter study evaluating the use and
impact of preoperative ultrasound assessment versus a control group for perioperative
management, complications and outcome of patients undergoing hip fracture.
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