Management and optimisation in the preoperative phase for patients with a fractured hip

Hip fractures represent a time-critical, systemic condition in older adults, characterised by frailty, multimorbidity, inflammation, immobility, pain, and high risk of medical complications and mortality. While population ageing is expected to drive a continued rise in absolute hip fracture numbers, contemporary evidence demonstrates declining age-standardised incidence in many high-income countries, highlighting the importance of optimising perioperative care pathways to mitigate morbidity and mortality. Contemporary evidence consistently supports early surgical management, typically within 24-48 h, provided reversible medical issues are addressed in parallel rather than through prolonged preoperative workup. Orthogeriatric co-management and structured multidisciplinary pathways reduce time to surgery, delirium incidence, length of stay, and mortality while improving functional recovery. Key optimisation domains include multimodal opioid-sparing analgesia, delirium prevention bundles, targeted cardiovascular stabilisation, pragmatic management of anti-thrombotic therapy, anaemia, infection, and individualised anaesthetic strategies. Evidence supports protocol-driven, multicomponent care bundles over isolated interventions to enable safe early surgery, reduce complications, and improve functional recovery in this vulnerable population.