HUNDREDS of elderly patients waiting for emergency hip surgery have to fast more than once because their operations are cancelled.

One in five people who fracture their hip in Scotland face going without food for hours in preparation for surgery, only for the procedure to be postponed.

They then face fasting again as hospital staff prepare to get them to theatre a second time.

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Experts say the problem, which can affect the wellbeing of already frail patients, occurs because the operating theatres in Scottish hospitals are too busy with other casualties.

It has been exposed by an audit of the way patients who fracture their hips are cared for nationwide.

The probe found significant improvement in hip fracture care against a raft of standards since 2012-13, but revealed wide variation still exists between hospitals.

In some centres, including the royal infirmaries in Edinburgh and Aberdeen as well as Crosshouse Hospital in Kilmarnock, more than a third of patients had to fast at least twice before their operation went ahead. In Edinburgh and Aberdeen well over half the patients were deprived of a drink for more than 10 hours before surgery, even though standards say patients should be encouraged to drink until two hours before going to theatre.

The likelihood of patients being fully assessed when they arrive in accident and emergency departments and are admitted to wards also varies around the country, according to the findings. A fifth of patients received all the recommended interventions in A&Es - including pain relief and pressure sore checks- during the latest audit. This is up on two per cent four years ago.

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A spokesman for charity Age Scotland said: “The audit reveals some noted improvements in hip (fracture) treatment over the past few years, but clearly some particular hospitals are falling behind in their duties to older patients awaiting surgery. Although it’s understandable that health boards want to use surgeons’ time and theatre space most efficiently, this is a poor excuse for making older patients wait unnecessarily and particularly making them fast repeatedly or be deprived fluids excessively. Future inspections should focus attention on reasons for the delays and inadequate communication with wards, and why variation in practice is so significant.”

More than 6000 people are admitted to hospital with a hip fracture in Scotland each year and it is the most common serious orthopaedic injury among the elderly.

In a bid to improve care of these patients their experiences were monitored over four months in 2012-13. Now a report has been published comparing these findings with a similar audit covering last winter.

Mr Graeme Holt, consultant orthopaedic surgeon and chair of the Scottish Hip Fracture Audit Group, said significant progress had been made. He said: "More patients get back home within 30 days and fewer patients are dying within 30 days and that is very encouraging."

He explained patients with hip fractures were managed in emergency trauma theatres which could be very busy, leading to operations being postponed. Patients who had been prepared for the procedure could also be found unfit for surgery, he said.

Those being treated at Edinburgh Royal Infirmary (ERI) appeared the most likely to be hit by delays, with the audit showing almost 30% waiting more than 48 hours for their operation. ERI patients also had a longer stay in hospital than people in other areas.

The findings are intended to be used by orthopaedic departments across Scotland to make improvements.

Mr Holt said: "Each hospital will have its own challenges. One of the things we have encouraged is a regular national meeting where we get together and discuss units that are doing well and how that has been achieved."

Health Secretary Shona Robison said: “Today’s latest figures are encouraging and demonstrate considerable improvements in care across Scotland, significant reductions in delays, more rapid recovery for patients and patients returning home more quickly than in 2012/13.

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“Clearly there is still work to do and I expect boards to work closely with the Scottish Hip Fracture Audit and Advisory Group to implement all recommendations contained within this report."