In this episode of Hipcast, we speak with three clinical experts about the complexities of surgical timing in hip fracture patients who are taking SGLT2 inhibitors and GLP-1 receptor agonists.

Professor Jacqueline Close (Consultant Geriatrician, Prince of Wales Hospital / Neuroscience Research Australia), A/Prof Katherine Tonks (Endocrinologist, Sydney Endocrinology / St Vincent’s Hospital) and Dr Louisa Lowes (Anaesthetist and Director of Perioperative Medicine, Prince of Wales Hospital) share insights from their respective disciplines on balancing surgical urgency with medication-related risks.

The discussion explores:

• Mechanisms and perioperative considerations of SGLT2 inhibitors and GLP-1 agonists
• How these agents influence timing and safety of hip fracture surgery
• Interdisciplinary strategies to minimise perioperative complications
• Practical take-aways for clinicians

🔗 Resources mentioned:

• 1. Australian Diabetes Society (ADS):
     Peri-operative Management of Diabetes Medications
  2. ANZCA Safety Alert: ALERT UPDATE May 2023 Periprocedural Diabetic Ketoacidosis (DKA) with SGLT2 Inhibitor Use In People with Diabetes
  3. ANZCA Safety Alert: Clinical Practice Recommendations regarding patients taking GLP-1 receptor agonists and dual GLP-1/GIP receptor co-agonists prior to anaesthesia or sedation for surgical and endoscopic procedures.
  4. Australian and New Zealand Hip Fracture Registry (ANZHFR):
     Clinical Care Standards and Annual Report
  5. A/Prof Katherine Tonks resource: Is your patient on a SGLT-2 Inhibitor?
  6. ANZCA Patient Instructions: Preparing for your medical procedure when taking some diabetes and/or weight loss medications

🎙️ Hipcast is hosted by Dr Niamh Dove and produced by the Australian and New Zealand Hip Fracture Registry, dedicated to improving outcomes and experiences for people with hip fracture and those who care for them.

In this special episode of Hipcast, host Dr Niamh Dove speaks with Nick May, husband and carer of his wife Fleur who sustained a hip fracture and underwent hospital treatment and recovery.

Nick shares his reflections on navigating the hospital experience, the realities of recovery at home, and how life changes after a hip fracture - from the viewpoint of the person providing day-to-day care. His story highlights the essential role of carers in supporting recovery and what health professionals can learn from their perspective.

This episode is brought to you by the Australian and New Zealand Hip Fracture Registry (ANZHFR), dedicated to improving outcomes and experiences for people with hip fracture and their families.

On this episode, A/Prof Jennifer Stevens and Emma Pauley share findings from their quality improvement project titled: A post-operative analgesic bundle of fascia iliaca catheter and celecoxib for elderly patients with hip fracture: a quality improvement project. 

Jenny is an Associate Professor at both University of Notre Dame and UNSW as well as an anaesthetist and pain specialist at St Vincent’s Campus in Sydney, Australia. Emma is a Senior Orthopaedic Physiotherapist, also at St Vincent’s Hospital Darlinghurst. 

Please find below the links for the resources mentioned in this episode:

• ANZCA Resources for Change: https://www.anzca.edu.au/getContentAsset/4e02b985-9852-426f-aa16-b7f06ac2725a/80feb437-d24d-46b8-a858-4a2a28b9b970/Celecoxib-guidelines-May-2024.pdf?language=en
• Gawthorne J, Stevens J, Faux  S, Leung J, McInnes E, Fasugba O, Mcelduff B, Middleton S. Can emergency nurses safely and effectively insert fascia iliaca blocks in patients with a fractured neck of femur? A prospective cohort study in an Australian emergency department. Journal of Clinical Nursing. 9th June 2021. https://doi.org/10.1111/jocn.15883
• Riley M, Tassie B, Gawthorne J, Hadzic R, Stevens J. Increased opioid consumption following regional nerve blockade: could fascia iliaca block be associated with rebound pain in neck of femur fracture? Br J Anaes. 10 May 2021. https://doi.org/10.1016/j.bja.2021.03.034 

On the episode, the Older Persons Emergency Network (OPEN) Clinical Director Dr Elizabeth (EJ) Marsden and OPEN nurse practitioner Sarah Bold share their teams achievements to provide pre-hospital hip fracture care. The OPEN Metro North  team provides a pre-hospital neck of femur fracture pathway as a Queensland Ambulance Service co-response emergency department substitution model to provide timely outreach care for frail older persons living in residential aged care facilities and the community.

Joining us on this episode to revisit and update on the topic of direct oral anticoagulants, or DOACS, and timing of surgery are Dr Hannah Seymour, a consultant geriatrician from Fiona Stanley Hospital in WA and Dr Seth Tarrant an orthopaedic surgeon from John Hunter Hospital NSW. 

We covered this topic on this Hipcast episode in 2024 with Hannah and Professor Rebecca Mitchell following the results of ANZHFR Sprint Audit and publication of the Fragility Fracture Networks’ consensus statement in the journal Anaesthesia.  We will also be looking at how time to surgery is tracking across AU and NZ and implications of this for practice.

Dr Suzanne Dyer presents on What the Evidence Tells Us in Rehabilitation at the ANZHFR Hipfest 2023. Dr Dyer is a senior research fellow at Flinders University, she’s worked as a researcher in both the public and private sector with expertise in evidence based methodologies including health technology assessment, systematic reviews, meta-analysis and guideline development. She’s the author of over 70 publications and reports including the Cochrane Review on Interventions for Improving Mobility after Hip Fracture.

Please find the mentioned research below:
- Interventions for improving mobility after hip fracture surgery in adults - 2022 Cochrane Review
- Multidisciplinary rehabilitation for older people with hip fractures - 2021 Cochrane Review
- Enhanced rehabilitation and care models for adults with dementia following hip fracture surgery - 2015 Cochrane Review

Joining the John Hunter Hospital hip fracture care team on Hipcast to sharing their insights into the multidisciplinary care approach of their site awarded the ANZHFR Australian Golden Hip 2023 Award for top performing hospital.

Joining us on the episode:

• Mrs Ramya Kunnath: Orthopaedic Clinical Nurse Consultant - Hunter New England LHD
• Dr Erica Epstein: Geriatrician - Hunter New England LHD
• Dr Seth Tarrant: Orthopaedic surgeon - Hunter New England LHD
• Prof Zsolt Balogh: Director of Trauma  - Hunter New England LHD 

Professor Kim Delbaere & Dr Rik Dawson share their work on raising awareness for falls prevention nationally. 

Kim is a Senior Principal Research Scientist at Neuroscience Research Australia and a Professor of Health Sciences at the University of New South Wales. She is the current President of the Australian and New Zealand Falls Prevention Society. 

Dr Rik Dawson is a Gerontological Physiotherapist and postdoctoral researcher at the Institute for Musculoskeletal Health at the University of Sydney. Rik is the current National President of the Australian Physiotherapy Association. 

A/Prof Danielle Ni Chroinin explores the effect of a multidisciplinary care bundle on the incidence of delirium after hip fracture surgery.

Links discussed:
1. The effect of a multidisciplinary care bundle on the incidence of delirium after hip fracture surgery: a quality improvement study (2020) in Anaesthesia
2. Delirium Reduction by Analgesia Management in Hip Fracture surgery (DRAM-HF): Exploration of perceived facilitators and barriers (2021) in Australasian Journal on Ageing
3. Clinical Practice Guideline: Orthogeriatric Hip Fracture Care (2023)

1 in 3 Australians aged 65 and over fall each year making it the leading cause of death for this age group.

Rik Dawson, an experienced physiotherapy and researcher, lifts the curtain to explain what is happening in residential care facilities in terms of physiotherapy care and rehabilitation and explores some important issues including:

•  The lack of rehabilitation available in residential aged care facilities;  
• The massive problem of falls in these facilities;
• The challenges of providing care and staffing as set by the Aged Care Act 1997 and the impact on coordinated care;
• Specific areas of focus in physiotherapy and residential aged care that warrant funding for improved quality of life outcomes.