Postoperative Complications of Hip Fracture in Older Adults

Hip fracture surgery in older adults carries high complication risk due to frailty, comorbidities, and physiological reserve depletion.

Major Complications

Complication	Incidence	Key Prevention
Surgical site infection	1–3%	Antibiotics, normothermia, glucose control
Venous thromboembolism (DVT/PE)	4–10% without prophylaxis	Pharmacologic (LMWH/DOAC) + mechanical (IPC) ≥14 days
Pneumonia	5–15%	Early mobilization, incentive spirometry, oral care, HOB elevation
Delirium	20–60%	Multicomponent non-pharm (HELP protocol), avoid anticholinergics/benzodiazepines
Cardiac events (MI, HF, arrhythmia)	3–8%	Preop optimization, beta-blocker continuation, hemodynamic monitoring
Stroke	1–3%	BP control, AF anticoagulation, early mobilization
Pressure injury	10–20%	Repositioning, support surfaces, nutrition
Urinary retention/UTI	15–30%	Limit catheter duration, timely voiding trials
Persistent pain / functional decline	30–50% at 1 yr	Multimodal analgesia, early PT/OT, geriatric co-management

Integrated Prevention: Orthogeriatric Co-Management

• Preoperative: comprehensive geriatric assessment, medication reconciliation, cardiac optimization.
• Perioperative: neuraxial anesthesia preferred, goal-directed fluids, tranexamic acid.
• Postoperative: early weight-bearing (day 0–1), protein supplementation, vitamin D, falls prevention, osteoporosis treatment initiation.

Mortality

30-day: 5–10%; 1-year: 20–30%. Half of 1-year mortality attributable to fracture sequelae.

Systematic, protocol-driven care reduces complications and restores independence.