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Iain Moppett OBE

@iainmoppett.bsky.social
1.4K followers 447 following 389 posts

Human, doctor, anaesthetist, academic - in that order. Director Centre for Research & Improvement at RCoA. Editor Anaesthesia. #HipFracture #AnSky #PatientSafety Views own. Work for University of Nottingham and Nottingham University Hospitals.

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Iain Moppett OBE @iainmoppett.bsky.social · 09/10/2026
Congratulations, Prof Leslie. Thoroughly well deserved. @bjajournals.bsky.social is in good hands.
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Man Clapping Enthusiastically
Alt: Man Clapping Enthusiastically
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ANZCA @anzca.bsky.social · 09/10/2026
Professor Kate Leslie AO FAHMS, a past president of ANZCA, has been appointed editor-in-chief of the British Journal of Anaesthesia (BJA), making her the first Australian in the role. Read more about Professor Leslie’s appointment here: bit.ly/4yf4LZQ
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Anaesthesia @anaesjournal.bsky.social · 08/10/2026
Beyond survival: understanding postoperative disability in peri-operative care "...disability has emerged as an important outcome that may better reflect the lived experience of patients after surgery compared with conventional endpoints alone." #AnSky #MedSky #SurgSky doi.org/10.1111/anae...
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British Geriatrics Society @gerisoc.bsky.social · 07/10/2026
We are pleased to endorse Clinical Guideline for Perioperative Care of People with Parkinson’s Disease, a multidisciplinary pathway guideline developed by the Centre for Perioperative Care with people living with Parkinson’s, carers and multidisciplinary clinical experts. buff.ly/fGIqpbx
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Alasdair MacLullich @amaclullich.bsky.social · 05/10/2026
Constipation is an unglamorous cause of delirium, and a common one. On many wards the bowel chart has a six day gap in it. Check the simple causes first.
Ancient Aliens guy gesturing. Top: "I'm not saying it was constipation". Bottom: 'But it was constipation.'
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Admirable Women @admirablewomen.bsky.social · 04/10/2026
English physician & epidemiologist Dr. Alice Stewart is best-known for her pioneering research in the 1950s that established a strong link between prenatal X-ray exposure and childhood leukemia. Her work influenced radiation protection standards. She was born #OTD in 1906. #WomenInSTEM #MedSky
Black-and-white photograph of English physician and pioneering epidemiologist Dr. Alice Stewart (1906–2002) working at her desk, symbolizing her groundbreaking research linking prenatal X-ray exposure to childhood leukemia. The composition positions Dr. Stewart on the left side of the frame, angled slightly toward the camera. She sits at a wooden desk with her body turned forward, leaning her forearms against the surface. Holding a pen in her right hand, she is captured in the act of writing on loose-leaf papers, looking directly at the viewer with a slight, knowing smile and an intelligent, engaged expression. Her dark hair is short, textured, and styled in loose curls around her face. She wears a crisp, light-colored medical lab coat over a textured collared shirt or blouse. The setting is a research lab or office environment. Positioned prominently in the background on the desk to her left is a large, classic black compound microscope. Stacks of research papers, documents, and reference materials are scattered across the workspace. The overall mood is intellectual, professional, and deeply focused, capturing a legendary scientist whose rigorous data collection transformed global radiation protection standards.
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Alasdair MacLullich @amaclullich.bsky.social · 03/10/2026
Post-operative delirium often begins in recovery, not on the ward. The first frightened hours after anaesthesia pass unwitnessed if we only screen at the next routine ward checks. It's good practice to screen in the recovery room (PACU). #periop #delirium
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Anaesthesia @anaesjournal.bsky.social · 01/10/2026
Outcomes and complications of the pericapsular nerve group block with phenol for non-operative hip fracture management in patients living with frailty #AnSky #RASky #frailty doi.org/10.1111/anae...
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Anaesthesia @anaesjournal.bsky.social · 30/09/2026
Pericapsular nerve group block + phenol 6% • for non-operative hip fracture management • in patients living with frailty ⚠️ "is an effective, minimally invasive procedure for pain management in addition to opioid-based pain relief" #AnSky #RASky doi.org/10.1111/anae...
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Iain Moppett OBE @iainmoppett.bsky.social · 25/09/2026
Thanks for sharing @liangrhea.bsky.social Good that this critique is coming from surgeons themselves. I suspect similar issues apply within my world (anaesthesia) and more broadly. Shout out to UK NICE who try to ensure that stuff we do has a clinical and cost-effectiveness base. #AnSky
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Rhea Liang @liangrhea.bsky.social · 25/09/2026
I don't know any surgeons who wake in the morning thinking 'yep, I'm going to do an operation today that carries no benefit'. 🤔 www.economist.com/science-and-...
economist.com
Many surgical interventions are little better than placebo
A succession of clinical trials is upending the field
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Iain Moppett OBE @iainmoppett.bsky.social · 25/09/2026
Want to see some cool applied science? My @uniofnottingham.bsky.social neurosurgical colleague, Stuart Smith, has been leading some work on ultra-rapid genetic diagnosis of brain tumours. www.bbc.co.uk/news/article... @braintumourrsch.bsky.social @nanoporetech.com
bbc.co.uk
Brain tumour diagnosis cut from weeks to hours with rapid new NHS test
The test means patients can start treatment sooner and are spared weeks of uncertainty.
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Christos Chamos @hamos1977.bsky.social · 23/09/2026
Here I am this afternoon, returning to the dog-eared, detached pages of a disintegrating old textbook to reread V/Q mismatch under anaesthesia, simply because I was annoyed with myself for having forgotten parts of it. It happens to other people too (the forgetting, I mean)? #ansky
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Iain Moppett OBE @iainmoppett.bsky.social · 22/09/2026
I know a lot of medics (me included) and others can find statistics a bit opaque and frequently (😉) misinterpret reported findings. Really nice article from a colleague using stories to explore these issues. onlinelibrary.wiley.com/doi/10.1002/... #AnSky #Stats
onlinelibrary.wiley.com
Teaching Thoughtful Statistical Inference: Stories for the World Beyond <fc><fi>p</fi></fc> < 0.05
Statistical hypothesis tests and p values are poorly understood by many students of statistics. Poor application and misinterpretation of statistical inference procedures are common in published rese...
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John Watson @dr-lungs.bsky.social · 19/09/2026
Ok. A change for me. This is not about politics. Or a silly joke. This is about chronic respiratory disease. Mine
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Alasdair MacLullich @amaclullich.bsky.social · 17/09/2026
If memory or thinking remains different after delirium, arrange clinical review. Recovery and longer-term cognitive change need to be considered separately.
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Alasdair MacLullich @amaclullich.bsky.social · 14/09/2026
For delirium researchers: Publishing delirium research should not require a four-figure fee. Delirium is open access: €20 to submit and a €280 publishing charge (APC) on acceptance. Peer review normally takes an estimated 4 to 6 weeks. deliriumjournal.com/for-aut... #Delirium
deliriumjournal.com
For Authors | Delirium
The open-access home for delirium research, quality improvement, reviews, protocols, and case reports.
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Alasdair MacLullich @amaclullich.bsky.social · 14/09/2026
As people become older and more frail, sometimes the doses of drugs that they are on become toxic. This can also happen acutely. Especially in the presence of acute injury. This is why medication review as part of delirium care is so important. #delirium
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Royal College of Anaesthetists @rcoanews.bsky.social · 07/09/2026
NAP8 update 🙌 The baseline surveys are done! The activity survey is done! We're 3 months into the NAP8 case registry, and almost 90 cases have been logged. Remember to discuss any potential complications below with your local co-ordinator. Learn more 👉 ow.ly/xURr50ZBRP3 #Medsky
NAP8 update
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Iain Moppett OBE @iainmoppett.bsky.social · 01/09/2026
New consensus guidelines on non-operative (or conservative) management of hip fracture published, led by @healthdataprof.bsky.social. A quick thread on why these are needed and what they say. As always, interested in people’s opinions. www.injuryjournal.com/article/S002... 1/N 🧵 #AnSky #GeriSky
injuryjournal.com
Operative and non-operative management of people with hip fracture: A modified-Delphi study to develop an international consensus
To develop a series of consensus statements regarding the operative and non-operative management of hip fracture patients.
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Elle Cordova @ellecordova.bsky.social · 08/09/2026
I am the very model of a modern day typographer A font take on the tune “Modern Major General” by Gilbert & Sullivan #typography #fonts #graphicdesign
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Altmetric @altmetric.com · 24/08/2026
🧵 (Part 1) Science is Not Just for Scientists In a few short years we have seen the rise of scammers, quacks, unlettered politicians assuming critical health infrastructure roles (with predictably devastating results) and more. Should "Science" just be for scientists? 1/25
A large collage of notable scientists including Carl Sagan, Richard Dawkins, Neil DeGrasse Tyson, Nikola Tesla and Albert Einstein.
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Centre for Perioperative Care (CPOC) @cpoc.bsky.social · 07/09/2026
CPOC is delighted to congratulate former Deputy Directors, @scarlettmcnally.bsky.social and @jkdhesi.bsky.social, on being awarded Honorary Fellowships of the @rcoanews.bsky.social (RCoA) at the Diplomates Ceremony on Friday 4 September - cpoc.org.uk/former-cpoc-...
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Prof Scarlett McNally @scarlettmcnally.bsky.social · 05/09/2026
It was surreal being awarded Honorary Fellowship of the Royal College of Anaesthetists! Thank you @rcoanews.bsky.social and @cpoc.bsky.social. @collegeofsurgeons.bsky.social @medicalwomenuk.bsky.social
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Iain Moppett OBE @iainmoppett.bsky.social · 01/09/2026
Conflict: I am an editor for Anaesthesia where some of the referenced work is published, and I sit on the National Hip Fracture Database advisory group. Opinions are all mine - no-one else's. END
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Iain Moppett OBE @iainmoppett.bsky.social · 01/09/2026
Caveat: These are my own reflections on work I was glad to be part of, alongside @healthdataprof.bsky.social, @antonyjohansen.bsky.social, Hanna Willems, Irewin Tabu and Hannah Seymour. Not everyone will agree with every statement - that’s fine, let’s discuss. 31/N
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Boss Love Questions: Ask Me Questions Cat
Alt: Cat wearing glasses leaning on computer: Can says 'Ask Me Questions'
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Iain Moppett OBE @iainmoppett.bsky.social · 01/09/2026
Limitations worth being upfront about: Our panel was thin on LMIC representation, and there’s a real lack of research comparing operative vs non-operative outcomes across differently-resourced settings. Generalisability has real limits. 30/N
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George Costanza: Why Must There Always Be a Problem?
Alt: George Costanza: Why Must There Always Be a Problem?
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Iain Moppett OBE @iainmoppett.bsky.social · 01/09/2026
Methods (cont.): The Delphi was convened by an FFN (Fragility Fracture Network) working group, and the panel spanned anaesthetists, orthopaedic/trauma surgeons and geriatricians. Relevant to members of @assocanaes.bsky.social, @gerisoc.bsky.social and @britorthopaedic.bsky.social alike. 29/N
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Iain Moppett OBE @iainmoppett.bsky.social · 01/09/2026
Methods: We ran a 2-round modified-Delphi with an international panel - 67 respondents round 1, 55 round 2, across 17 countries - rating statements on their importance in guiding operative vs non-operative decisions. Reported using the ACCORD framework. pubmed.ncbi.nlm.nih.gov/38709851/ 28/N
pubmed.ncbi.nlm.nih.gov
ACcurate COnsensus Reporting Document (ACCORD) explanation and elaboration: Guidance and examples to support reporting consensus methods - PubMed
The ACCORD materials - including the reporting guideline and this explanation and elaboration document - can be used by anyone reporting a consensus exercise used in the context of health research. As a reporting guideline, ACCORD helps researchers to be transparent about the materials, resources (b …
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Iain Moppett OBE @iainmoppett.bsky.social · 01/09/2026
Bottom line: These are statements of principle, not rules - deliberately ‘should’ and ‘offer’ not ‘must’. For the vast majority of people with a hip fracture, surgery remains the right plan. Non-op options deserve the same rigour, decision-making and governance. 27/N
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Iain Moppett OBE @iainmoppett.bsky.social · 01/09/2026
Statement 13/14 (cont.): currently we don’t know enough about why patients receive non-operative management and what happens to them afterwards. We hope that FFN and individual national registries will pick this up so we get a much better picture to help inform our patients. 26/N
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Commander Data's Sarcastic Look
Alt: Commander Data smiling.
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Iain Moppett OBE @iainmoppett.bsky.social · 01/09/2026
Statements 13/14: National hip fracture registries are useful for informing shared decision-making on operative care - and should also record why patients choose non-op management, and their outcomes, using standardised classification. 25/N
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Iain Moppett OBE @iainmoppett.bsky.social · 01/09/2026
Statement 12 (cont.): advanced care planning. There are no perfect tools for predicting mortality, but even a fairly crude split of the Nottingham Hip Fracture Score can identify a fairly high-risk group. pubmed.ncbi.nlm.nih.gov/21278153/ 24/N
pubmed.ncbi.nlm.nih.gov
Nottingham Hip Fracture Score as a predictor of one year mortality in patients undergoing surgical repair of fractured neck of femur - PubMed
NHFS can be used to stratify the risk of 1 yr mortality after hip fracture surgery.
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Iain Moppett OBE @iainmoppett.bsky.social · 01/09/2026
Statement 12: Advance care planning should happen for patients at high risk of death within 12 months of a hip fracture. This is about planning ahead, not just responding to imminent dying. 23/N
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Iain Moppett OBE @iainmoppett.bsky.social · 01/09/2026
Statement 11 (cont.): I suspect some places do this really well – after all most geriatricians are experts in palliative care – but sometimes it’s more of a mindset. Has anyone actually written (and explained to the patient / family) that the surgical intent is focussed on palliation? 22/N
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Maximus from Tangled: Explain
Alt: Maximus from Tangled: Explain
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Iain Moppett OBE @iainmoppett.bsky.social · 01/09/2026
Statement 11: Hip fracture can be the precipitant of terminal decline, and either operative or non-operative management can form part of an agreed palliative care approach. Surgery and palliative care aren’t mutually exclusive. 21/N
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Iain Moppett OBE @iainmoppett.bsky.social · 01/09/2026
Statement 10 (cont.): The number of people having non-operative / conservative management is always likely to be small, but that doesn’t mean that units (or national organisations) can’t think ahead of time as to what best care looks like. 20/N
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Pooh Think Gif
Alt: Pooh Bear: Saying 'think, think, think'
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Iain Moppett OBE @iainmoppett.bsky.social · 01/09/2026
Statement 10: If non-op management is chosen, there should be clear, patient-centred policies to optimise comfort and dignity. Only 24% of our panellists’ facilities had any protocol for this - it seems the exception, not the rule. 19/N
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Skipper: Follow The Rules
Alt: Skipper: Follow The Rules
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Iain Moppett OBE @iainmoppett.bsky.social · 01/09/2026
Statement 9 (cont.): International data (which aren’t great) suggest that currently non-op management is associated with high, but not 100% early mortality. bsky.app/profile/iain... Hence, the importance of the word ‘consider’ – what does / would the patient want? See statement 8! 👆 18/N
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Iain Moppett OBE @iainmoppett.bsky.social · 01/09/2026
Statement 9 (cont.): writing ‘at high risk of death’ is pretty straightforward, but as yet, there aren’t any very reliable tools to identify precisely who these people are. Expert clinical judgement is important but not perfect either. pubmed.ncbi.nlm.nih.gov/28585391/ 17/N
pubmed.ncbi.nlm.nih.gov
Understanding mortality rates after hip fracture repair using ASA physical status in the National Hip Fracture Database - PubMed
Hip fracture is the most common reason for older patients to need emergency anaesthesia and surgery. Up to one-third of patients die in the year after hip fracture, but this view of outcome may encourage therapeutic nihilism in peri-operative decisions and discussions. We used a multicentre national …
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Iain Moppett OBE @iainmoppett.bsky.social · 01/09/2026
Statements 9a/9b: Non-op management should be considered for palliation in patients at high risk of dying within the next week (9a), or the next month (9b). 16/N
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Iain Moppett OBE @iainmoppett.bsky.social · 01/09/2026
Statement 8 is an important addition to no 7 ☝️: Shared decision making should prioritise the patient’s own wishes, or - if they can’t participate - the priorities reported by people who know them best. Not the clinician’s preference, and not necessarily the family’s either. 15/N
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Iain Moppett OBE @iainmoppett.bsky.social · 01/09/2026
Statement 7: Shared decision-making between clinicians, the patient and (where appropriate) their family should inform whether surgery goes ahead. I hope this isn’t controversial - but worth a formal statement given how often this doesn’t happen well. 14/N
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Man Says Agreed
Alt: Man Says Agreed
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Iain Moppett OBE @iainmoppett.bsky.social · 01/09/2026
Statement 6 (cont.): Registry data suggest around half of non-op management in high-income countries is for fracture-pattern reasons, not comorbidity / end-of-life reasons. www.nhfd.co.uk/reportopen/N... Lumping them together obscures two very different patient groups and decision making. 13/N
nhfd.co.uk
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Iain Moppett OBE @iainmoppett.bsky.social · 01/09/2026
Statement 6 is different - about fracture pattern, not frailty: Some hip fractures are mechanically stable or already healing and don’t need surgery. We kept this separate from the frailty / end-of-life statements deliberately. 12/N
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Iain Moppett OBE @iainmoppett.bsky.social · 01/09/2026
Statement 5 (cont.): the ‘costs’ (financial, familial, social etc) of operating and not operating are very context dependent. Clinicians need to be mindful of the overall impact of the options being discussed. 11/N
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Crash Out: Imbalanced Scale
Alt: A Scale tilting from side to side. Representing decision making weighing everything in the balance.
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Iain Moppett OBE @iainmoppett.bsky.social · 01/09/2026
Statement 5: Longer-term health and social care costs should be part of the conversation too, not just immediate surgical risk. Cost-utility work in frail institutionalised patients shows this isn’t just an academic point. pmc.ncbi.nlm.nih.gov/articles/PMC... 10/N
pmc.ncbi.nlm.nih.gov
Nonoperative versus operative management of frail institutionalized older patients with a proximal femoral fracture: a cost-utility analysis alongside a multicenter prospective cohort study
Hip fractures are associated with significant healthcare costs. In frail institutionalized patients, the costs of nonoperative management are less than operative management with comparable short-term ...
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Iain Moppett OBE @iainmoppett.bsky.social · 01/09/2026
Statement 4: Being older, having delirium or dementia, are not in themselves a reason to withhold surgery. Age or cognitive impairment are important context but not deciding factors - outcomes for people with dementia are more nuanced than that. pmc.ncbi.nlm.nih.gov/articles/PMC... 9/N
pmc.ncbi.nlm.nih.gov
Association of Clinical Outcomes With Surgical Repair of Hip Fracture vs Nonsurgical Management in Nursing Home Residents With Advanced Dementia
The decision whether to surgically repair a hip fracture in nursing home (NH) residents with advanced dementia can be challenging. To compare outcomes, including survival, among NH residents with adva...
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Iain Moppett OBE @iainmoppett.bsky.social · 01/09/2026
Statement 3: Early death within a month of surgery can still happen even with good, shared decision-making. That doesn’t mean the decision to operate was wrong. Open, honest communication with families beforehand is vital. pubmed.ncbi.nlm.nih.gov/32907702/ 8/N
pubmed.ncbi.nlm.nih.gov
Prognosis of nonoperative treatment in elderly patients with a hip fracture: A systematic review and meta-analysis - PubMed
Nonoperative management of frail elderly patients with a hip fracture is associated with a poor prognosis. Heterogenous study cohorts and limited outcomes were reported. Current literature shows a lack of evidence of the true prognosis of nonoperative management of frail elderly patient with a hip f …
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Iain Moppett OBE @iainmoppett.bsky.social · 01/09/2026
Statement 2 (cont.): This is really important context setting about non-operative management of hip fracture. As with other aspects of palliative / end of life care, we shouldn’t equate non-surgical pathways with doing nothing. 7/N
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