Preoperative evaluation of elderly patients with hip fracture

Hip fracture is one the most frequent cause of hospitalization in developed countries [1]. These patients are old (> 90% aged over 70 years) often with one or more severe comorbidities and functional and cognitive impairment. In my opinion the more relevant question to be answered is: surgery for hip fracture should effectively be considered an intermediate risk surgery as suggested by ACC/AHA and ESC guidelines? [2-3]. The blood losses related to surgical act, often not negligible, and the effects of spinal anaesthesia, which may cause an uncontrollable decrease in systemic vascular resistance, may increase significantly the risk of severe hypotension that in frail elderly patients, frequently affected by serious comorbidity, may be associated with an increase in severe complications or death.