Clifford Bowens
Keynote: Surgery Curr Res
The presentation will review the current literature regarding perioperative optimization of hip fracture patients. This will be done in a case report format, utilizing a patient with co-morbid diseases which are commonly seen in this patient population. Medline and PubMed searches were performed for relevant publications regarding preoperative evaluation of hip fracture patients and anesthesia for hip fracture patients. Keywords included the following: ?hip fracture?, ?preoperative evaluation?, ?regional anesthesia?, and ?general anesthesia?. MeSH headings included: ?hip fracture?, ?anesthesia, conduction?, and ?nerve block?. The search was limited to human studies from 1975 to the present, and identified 397 abstracts that were reviewed. The resulting publication list was then hand searched, emphasizing randomized controlled trials, reviews, and meta-analyses. One hundred twenty-five articles were read and reference lists reviewed. Cardiac, pulmonary, liver, renal, endocrine (diabetes), and cognitive preoperative optimization should be conducted for hip fracture patientsto improve outcomes. Regional anesthesia compared to general anesthesia has been shown to reduce short-term mortality, deep vein thrombosis, fatal pulmonary embolism, acute postoperative confusion, and operative blood loss, while general anesthesia may have less hypotension and fewer cerebral vascular accidents.For hip fracture patients, higher than average mortality risk decreases during the first 2 years after the fracture but does not return to the rate of gender and age-matched controls even after 10 years of follow-up. Preoperative optimization, early surgery (< 48 hours), and good postoperative care may improve long-term outcomes.
Clifford Bowens completed his medical training at Duke University School of Medicine in 1993. He served in the Unites States Navy as a General Medical Officer, earning the rank: Commander, Medical Corps. Dr. Bowens completed his residency in Anesthesia at Penn State Hershey Medical Center. He is presently an Assistant Professor in the Department of Anesthesiology, Vanderbilt University School of Medicine.He serves as the Medical Director, Orthopedic Anesthesia, and has published several journal articles and book chapters.
