The National Patient Safety Agency (NPSA) has issued a rapid response report on "Mitigating surgical risk in patients undergoing hip arthroplasty for fractures of the proximal femur".
The most common cause of sudden intra-operative death during this surgery is the occurrence of venous embolisation of fat and bone marrow contents. This occurs during the instrumentation and reaming of any long bone or any manoeuvre that raises the pressure within that bone.
The NPSA pointed out that 26 patient deaths and six cases of severe harm were reported to the agency between October 2003 and October 2008 in patients having a partial or total hip replacement where bone cement was used. The majority related to older patients undergoing emergency hip fracture.
The NPSA is therefore advising local organisations to report all deaths and incidents in such cases and to adopt best practice techniques in surgery and anaesthesia.
This includes identifying patients most at risk and stabilising their medical condition before surgery. Skilled anaesthetic input and communication between surgeon and anaesthetist at critical points during the surgery is vital. Best surgical technique should be used, including methods to reduce the pressure in the intramedullary canal. Bone cement, if used, should be introduced from below upwards.
Dr Kevin Cleary, Medical Director of the NPSA said: “For certain patients the short term risks of using cement in orthopaedic surgery need to be balanced against the long term benefits. This NPSA report shares evidence of harm from hospitals across the country and indicates certain practical steps which can be taken by surgical and anaesthetic staff to reduce risks to patients. By asking staff to report all serious incidents to the NPSA, we hope to improve learning and make this common procedure even safer for patients.”
