In Reply

We thank Dr. Khan et al. for providing a useful synopsis of recent relevant British and European literature, highlighting the work since 2007 of the National Hip Fracture Database in the United Kingdom. They reinforce the importance of prompt surgery and multidisciplinary team care for managing these complex, frail, elderly patients. We regret that the likelihood for useful data collection from the world’s greatest per capita consumer of health care remains limited. There are no sizeable databases in the United States that focus on these patients. However, we are pleased that the American Academy of Orthopedic Surgeons has recently published an easy-to-read guideline on the management of hip fractures in the elderly that has been endorsed by eight U.S. Specialist Societies.¹  Interestingly, sections on perioperative pain management and anesthesia, seemingly completed without formal input from anesthesiology and associated specialist societies, provide a robust conclusion that “strong evidence supports similar outcomes for general or spinal anesthesia for patients undergoing hip fracture.”²  We compliment our British colleagues on their diligence and multidisciplinary cooperation while concurring that this major, developed world, healthcare problem presents abundant opportunities for further research.