Establishing expert consensus on essential perioperative management components for hip fracture patients aged over 75: a national modified Delphi study.

INTRODUCTION

Anesthesiologists play a central role in optimizing perioperative care and improving outcomes for patients with hip fractures (HF). Standardized care bundles are essential to guide clinicians, enhance expertise, and improve overall quality of care. We conducted a nationwide modified Delphi study to establish French expert consensus on key components of a standardized care bundle for patients over 75 years old with HF.

METHODS

A two-round modified Delphi process was conducted with 30 multidisciplinary experts representative of major French academic societies to assess consensus on perioperative care practices for HF in patients over 75. Experts rated 34 clinically relevant items using a 9-point Likert scale, with consensus defined as ≥70% rating ranging from 7 to 9 for agreement or 1 to 3 for disagreement. The process was conducted via the REDCap platform and adhered to ethical and data protection standards.

RESULTS

The expert panel included 11 (36.7%) anesthesiologists, 9 (30%) geriatricians, 6 (20%) orthopedic surgeons, and 4 (13.3%) hospital pharmacists. Agreement consensus was reached for 29 out of 34 proposed items. A shortlist of 12 items that achieved over 90% consensus was identified, comprising 2 organizational, 7 perioperative, and 3 surgical items.

DISCUSSION: The bundle of care for HF elaborated in this study provides perioperative teams with clear, actionable objectives to improve care quality and equity. Its impact on patient outcomes warrants further evaluation.