Concerning the pre-operative status of these patients, the American Society of Anaesthesia (ASA) score is used to assess these patients, ranging from 1 to 4 where 1 is most healthy and 4 is anaesthetically unfit. We have <3% of patients which belong the ASA 1. Between 46% were ASA 2 and the others, 52% were ASA 3. Only 3% of patients were recorded to be completely healthy when they are admitted to the hospital. About half of the patients had three or more comorbidities. The commonest comorbidities are hypertension, diabetes and dementia. Regarding the PCI-32765 fracture patterns, 49% are femoral neck fractures. The other 49% are intertrochanteric fractures

and the remaining 2% sub-trochanteric fractures. Cannulated screws fixation was done in 16% of patients. The remaining 27%

of patients had hemiarthroplasty done. There was an increase selleck inhibitor of using cephalomedullary device in recent years. Eight percent of patients had cephalomedullary device fixation in 2007 and the number was increased to 22% in 2009. This was also reflected in the general decrease in use of dynamic hip screw from 45% in 2007 to 35% in 2009. After the operation, 72% did not need any blood transfusion. The rest needed less than 2 units of blood transfusion. Among these patients, about 70% come from home and the rest come from old age home or nursing home. Regarding the walking ability, unaided walker before the operation comprised 37% of patients. Majority of these patients, 56%, already needs walking aids before surgeries. Others are mainly chair-bound. While we need to predict the prognosis of the hip fracture patients, besides assessing the premorbid VX-680 datasheet physical state of the patient, the mental state and the ability to take care of themselves are also very important [6]. MMSE is used to assess the mental state of the patients. In the last 3 years, the statistics remain static. About 56% failed the MMSE which means score was less than 18. Regarding the MBI score, 43% of them are completely independent. It reflects many of these patients need

some kind of help during their daily lives. One of the main goals of our clinical pathway is to improve the hospital length of stay in both acute and convalescence hospital. As previously mentioned, the average pre-operative length of stay in 2006 is 6.1 days. After the implementation of the pathway, it Dichloromethane dehalogenase drastically shortened the length of stay to 2.53 days in 2007 and 1.42 days in 2009. The post-operative length of stay and the total length of stay were also decreased to 5.54 and 6.66 days, respectively (Fig. 2). With regards to the length of stay of convalescence hospital, there was also a drastic decline from the around 40 days in 2006 to 22.8 days in 2009 (Fig. 3). Fig. 2 Length of stay in acute hospital Fig. 3 Length of stay in convalescence hospital The implementation of clinical pathway also improved the incidence of hospital acquired pressure sore. The incidence decreased from 4.3% to 0.