EP133 Hip fracture pathway standards at cork university hospital (CUH), Ireland

<h3>Background and Aims</h3> Hip fractures are common and associated with adverse outcomes in older, multi-co-morbid, frail adults. Evidence based protocolised care is associated with enhanced patient outcomes. A perioperative pathway incorporating 9 standards of anaesthesia care was introduced at CUH in 2017. This pathway complemented national standards for hip fracture care (https://www.noca.ie/audits/irish-hip-fracture-database/). The 9 anaesthesia standards are: • Preoperative: regional analgesia (RA), correction of anaemia, discussion and mitigation of bone cement implantation syndrome; • Anaesthesia: low dose spinal anaesthesia (or propofol TIVA with EEG monitoring), maintenance of blood pressure within 10% of baseline or MAP≥ 80 mmHg; • Postoperative: continuous RA; • All phases: avoidance of benzodiazepines, avoidance of NSAIDs, use of immediate release oral morphine. This prospective audit aimed to measure compliance with pathway standards and evaluate postoperative pain outcomes. <h3>Methods</h3> The medical records of 60 patients were included. Patients were visited on the first post operative day to evaluate postoperative pain scores and ability to ambulate. <h3>Results</h3> Data was obtained from 60 patients, median age of 78 [50–96], median clinical frailty score of 5[5–6], of whom 39(65%) were female. Data obtained on anaesthesia standards are contained in table 1(Preoperative, peri-operative and postoperative management under hip fracture pathway standards). Pain score (VRS on movement) was ≤5 in 37 and 43 patients on POD1 and POD2 with 42 and 49 patients ambulating onPOD1 and POD2 respectively. <h3>Conclusions</h3> Patient pain outcomes and mobilization following hip fracture surgery are largely in line with expectations. Further work is needed to improve compliance with anaesthesia standards.