Anesthesiologist-led care speeds surgery and reduces complications for hip fracture patients

When anesthesiologists lead the preoperative process, patients undergoing surgery for hip fractures - one of the leading causes of hospitalization in older adults - get to the operating room (OR) faster and have fewer complications, according to a study presented at the ANESTHESIOLOGY^® 2025 annual meeting.

Due to unnecessary consultations and medical tests that can occur prior to getting patients to the OR, hip fracture patients often experience surgical delays of 24 hours or more. These delays can sharply raise the risk of complications, such as blood clots, infections and death. Additionally, because hip fracture patients are usually older, frail and have multiple health conditions, the traumatic nature of the injury and immobilization can cause a rapid deterioration in physical and mental well-being. The faster patients get to the OR to reverse the trauma and start recovery, the better their outcome, the authors note.

Anesthesiologists are uniquely trained to quickly identify any conditions that must be addressed before surgery, as well as recognize those that can wait until after the procedure. After a hip fracture, every hour counts, and by avoiding unnecessary delays and focusing on what truly matters for safe surgery, we can help patients get to surgery and back on their feet faster."

Sabatino Leffe, D.O., senior author of the study and vice chairman of Northwell Southshore University Hospital, Bay Shore, New York

At most hospitals, hip fracture patients are seen by an emergency room or orthopedic physician who works with the internal medicine physician or hospitalist to admit the patient and schedule the surgery. The physician(s) may order various tests to rule out heart, neurological or other issues, even when patients don't have active symptoms or the test results won't change the immediate management of the patient. This can delay surgery for hours and sometimes days.

In the study, researchers developed an anesthesiologist-led process early in the admission process for hip fracture patients. Anesthesiologists assessed patients to ensure they were healthy to undergo anesthesia in order to reach the OR as soon as possible. They determined if the patient's heart and lungs were stable, standard tests were normal and less urgent issues could be handled after surgery. If a serious problem was found - such as an uncontrolled heart rhythm or fluid in the lungs - the anesthesiologist consulted with the appropriate specialist and set clear treatment goals to get the patient stabilized and into surgery as quickly as possible.

To determine if the anesthesiologist-led system made a difference, researchers compared 130 patients treated with the traditional approach to 392 patients treated with the anesthesiologist-led approach. The average age of the patients in both groups was 79.

Those in the traditional process group were brought to the OR an average of 30.8 hours after admission, while those in the anesthesiologist-led group were brought to the OR an average of 25.7 hours after admission, about five hours faster. Patients in the anesthesiologist-led group had significantly fewer complications than those in the traditional group. For example, those in the anesthesiologist-led group had 59% fewer heart or lung complications and 75% fewer thromboembolic complications (such as blood clots) than those in the traditional group. There was no significant difference between the groups regarding length of stay, infection or death.

An aging population is driving a dramatic rise in the incidence of hip fractures, which are typically caused by a combination of having fragile bones (osteoporosis) and falling or other trauma, said Dr. Leffe. About 350,000 Americans fracture a hip annually, according to research. Many never regain their prior level of mobility and independence and/or suffer from long-term complications, including cognitive decline, chronic pain, pneumonia or bedsores.

"Our study demonstrates that a preoperative process primarily led by the anesthesiologist results in markedly improved time to surgery, with fewer complications and no increase in deaths or length of stay," said Surya Indukuri, B.S., lead author of the study and a medical student at Zucker School of Medicine at Hofstra University, Uniondale, New York. "We are confident this expedited care will reduce unnecessary testing and shorten hospital stays, which should result in significant cost savings."