The Risk Assessment, Prevention And Management Of Peri-Operative Stroke In Elderly Patients With Hip Fractures

Objective: This study aims to investigate the risk assessment,prevention and management of perioperative stroke in elderly patients with hip fractures.Methods: A total of 179 patients aged 65 years and even older were admitted to our department due to hip fracture,the strategy of perioperative stroke risk control was studied retrospectively,including preoperative stroke risk screening and treating,the key population for stroke prevention identifying,the preoperative stroke risk factor controlling,intraoperative monitoring,postoperative treating;And the incidence of perioperative stroke was recorded and analysised.Results: In this group,24(13.41%)did not receive operative treatments.The report of head and neck CTA showed severe stenosis or occlusion of the intracranial artery and the internal carotid artery in 9(5.03%)patients.Of these 9(5.03%)patients,5(2.79%)underwent cerebrovascular digital subtraction angiography(DSA)and interventional therapy,followed by the postoperative antithrombotic therapy with aspirin,clopidogrel and low molecular weight heparin,and the operation to treat the hip fracture was implemented 10 days later,finally they were discharged uneventfully.1(0.56%)patient who had DSA performed had no indication of interventional therapy,so he was arranged with scheduled orthopaedic surgery;postoperatively,he was discharged uneventfully.3(1.68%)patients refused to receive the further DSA examination or interventional therapy after they were informed of the risks for operation,and strongly demand for orthopaedic surgery while voluntarily at their own risks;they were discharged uneventfully.2(1.12%)patients were found to have cerebral aneurysm,diagnosed by CTA and DSA;they did not specifically managed,and underwent surgery for hip fracture.In 2(1.12%)patients,new occurrence of cerebral infarction was diagnosed before the operation,and head and carotid stenting was performed in the department of cerebrovascular surgery,followed by combined co-antithrombotic therapy with use of aspirin,clopidogrel and low molecular weight heparin;4 weeks later,orthopaedic surgery for hip fracture was performed,and they were discharged uneventfully.In 2(1.12%)patients,new cerebral infarction was diagnosed and they were transferred to the department of neurology for treatment.Conclusions: The thorough preoperative risk screening for stroke and appropriate management,proper implementation of perioperative anti-platelet and anti-thrombotic therapy,intense intra-operative monitoring and active postoperative management are necessary.In this way,hip fracture surgical treatments can be performed as soon as possible for both new and high-risk stroke patients.