Cleveland Clinic journal of medicine
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Patients with hip fracture benefit from a multidisciplinary team approach for preoperative and postoperative care. Team members, consisting of the orthopedic surgeon, internal medicine consultant, and anesthesiologist, should each have a role in determining a patient's readiness for surgery and communicate with one another about appropriate management. ⋯ Nondisplaced (impacted) femoral neck fractures, however, should be repaired within 6 hours if possible to avert avascular necrosis of the femoral head and the need for total hip replacement. The following interventions are helpful for preventing complications following hip fracture repair: perioperative prophylaxis against infection.
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Case Reports
Perioperative management of diabetes mellitus: how should we act on the limited evidence?
Patients with diabetes mellitus are at higher risk for complications from surgery than their nondiabetic counterparts. Evidence-based guidance on the perioperative management of diabetic patients is still very limited. ⋯ Insulin is the mainstay of perioperative glucose management, and intensive insulin therapy (to a target blood glucose of 110 mg/dL or lower) improves a range of clinical outcomes in critically ill patients relative to less aggressive insulin strategies. There is little role for oral antidiabetic medications in the early postoperative phase.
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Perioperative management is typically more complicated in older patients than in younger patients and requires more assessment and evaluation before surgery as well as precautionary steps after surgery to manage these high-risk patients.