Risks and Harms of Implementing this Recommendation
Higher morbidity, mortality, and longer hospital stays have been shown to be associated with non-operative treatment. The benefit of avoiding surgery and anesthesia was contrasted with a failure rate of approximately 20% in the non-operative treatment group that required surgery.
Given high failure rates with non-operative treatment, clinical equipoise is lacking, making a study on non-operative treatment of hip fractures unethical. While there are clearly hip fracture patients with end of life issues who may be appropriate for non-operative treatment, surgical fixation may decrease pain, facilitate hygiene and nursing, and improve mobilization for end of life comfort.
Special consideration for end of life issues, risks and limited benefits of surgery and the balancing of surgical goals with patient and family wishes.