Effect of Preoperative Transthoracic Echocardiogram on Mortality and Surgical Timing in Elderly Adults with Hip Fracture

Luttrell, Kevin; Nana, Arvind

doi:10.1111/jgs.13840

Cited by 28 publications

(21 citation statements)

References 22 publications

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“…This finding is consistent with previous reports that arrhythmia affects perioperative mortality and length of hospital stay [24]. Age was also found to affect short-term mortality [21,[25][26][27]. According to a previous study by Dodd et al [28], the incidence of 30-day mortality is significantly higher in older patients, and several previous studies have also reported that advanced age affects postoperative mortality [29].…”

Section: Discussionsupporting

confidence: 90%

Association between Preoperative Transthoracic Echocardiography and Clinical Outcomes after Scheduled Hip Fracture Surgery in Geriatric Patients

Lee

Kim

2020

Soonchunhyang Med Sci

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Objective: Hip fracture is a major problem for elderly patients and is expected to become more common as society ages. Transthoracic echocardiography (TTE) is still widely performed for cardiac risk assessment, while routine echocardiography is not recommended in patients undergoing non-cardiac surgery. Thus, we evaluated the relationship between TTE-related variables and postoperative outcomes in elderly patients with hip fracture. Methods: This study consisted of a single-center, retrospective medical record review including a total of 356 patients. The study population included patients 65 years of age and older who underwent TTE for preoperative assessment within 1 month before the scheduled hip fracture surgery between January 2013 and October 2016. Results: In total, 356 patients were included. Seven patients died within 30 days after surgery. Advanced age (odds ratio [OR], 1.14; 95% confidence interval [CI], 1-1.3; P< 0.05), increased left ventricular ejection fraction (OR, 1.26; 95% CI, 1.07-1.48; P< 0.05), and arrhythmia (OR, 64.99; 95% CI, 3.91-1,079.91; P< 0.05) were all significant risk factors for 30-day mortality. Increased left atrium volume was associated with 180-day mortality (OR, 1.02; 95% CI, 1-1.04; P< 0.05). Conclusion: In elderly patients undergoing hip fracture surgery, preoperative TTE is not a useful predictive factor for postoperative mortality.

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Section: Discussionsupporting

confidence: 90%

Association between Preoperative Transthoracic Echocardiography and Clinical Outcomes after Scheduled Hip Fracture Surgery in Geriatric Patients

Lee

Kim

2020

Soonchunhyang Med Sci

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“…Luttrell et al evaluated the impact of preoperative TTE on the elderly hip fractures (131 patients with TTE, 563 patients without TTE). They concluded that the patients with preoperative TTE had obvious longer waiting time to surgery [15]. Harun et al…”

Section: Discussionmentioning

confidence: 99%

Clinical guidelines reduce unnecessary preoperative echocardiograph in elderly hip fracture patients

Chen¹,

Ma²,

Li³

et al. 2020

Preprint

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Background The American College of Cardiology (ACC) and the American Heart Association (AHA) have set up guidelines for preoperative usage of transthoracic echocardiograph (TTE) in case of non-cardiac surgery. Unnecessary TTE would increase hospital cost and delay surgery. Therefore, we aimed to analyze whether the TTE before hip fracture surgery was in accordance with guidelines and what the effects were on outcome. Methods 281 elderly patients who had surgery for an isolated hip fracture were involved. The preoperative TTE test and adherence to the guideline were analyzed. TTE reports were reviewed for the presence of major cardiac abnormality with potentiality to change perioperative management, including left ventricular systolic or diastolic dysfunction, pericardial effusion, moderate or severe valvular disease, and pulmonary hypertension. Primary outcome was time to surgery (TTS), length of hospital stay (LLS), postoperative complications. Secondary outcome was sensitivity and specificity of accordance with the guideline for identifying which patients would have TTE that demonstrated major cardiac abnormality. Results Of the 281 patients included, 174 patients (61.9%) received the TTE, whereas 107 patients did not. Only 71 of the 174 patients (40.8%) with TTE met the guidelines. Among the 202 patients who did not meet the guidelines (103 with TTE and 99 without TTE), those who received a preoperative TTE had a longer TTS (4.24 vs. 2.10 days, P = 0.000) and LOS (10.44 vs. 7.72 days, P=0.000). There were no differences in postoperative complication, the sensitivity and specificity of guidelines as the screening tool to identify patients with major cardiac abnormality was 86.7% and 68.7%. Conclusion Preoperative TTE is frequently overused out of guidelines and lead to unnecessary surgery delay while not reducing the rate of postoperative complications. Stricter adherence to guidelines should be recommended, as it would help decrease unnecessary test.

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“…It has been suggested to routinely perform an echocardiography in elderly patients with hip fractures [21]. Some authors have reported a benefit of routine echocardiography on mortality after hip fracture surgery [22], where others have not [23,24]. Screening all hip fracture patients with transthoracic echocardiography (TTE) identified in 8% of patients significant aortic stenosis.…”

Section: Discussionmentioning

confidence: 99%

Cardiac overscreening hip fracture patients

Smeets

Wunnik

Poeze

et al. 2019

Arch Orthop Trauma Surg

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Background The aim of this study was to prospectively investigate the adherence to the American College of Cardiology (ACC) and the American Heart Association guidelines for perioperative assessment of patients with hip fracture in daily clinical practice and how this might affect outcome. Methods This prospective cohort study from Maastricht University Medical Centre included 166 hip fracture patients within a 3-year inclusion period. The preoperative cardiac screening and adherence to the ACC/AHA guideline were analyzed. Cardiac risk was classified as low, intermediate and high risk. Secondary outcome measurements were delay to surgery, perioperative complications and in-hospital, 30-day, 1-year and 2-year mortality. Results According to the ACC/AHA guideline, 87% of patients received correct preoperative cardiac screening. The most important reason for incorrect preoperative cardiac screening was overscreening (> 90%). Multivariate analysis showed that a cardiac consultation (p = 0.003) and overscreening (p = 0.02) as significant predictors for increased delay to surgery, while age, sex, previous cardiac history and preoperative mobility were not. High risk patients had in comparison with low risk patients a significantly higher relative risk ratio for in-hospital mortality (RR 6, 95% CI 2-17). Multivariate analysis showed that a previous cardiac history and increased delay to surgery were predictors for early mortality. High age and previous cardiac history were risk factors for late mortality. Conclusion Preoperative cardiac screening for hip fracture patients in adherence to the ACC/AHA guideline is associated with a diminished use of preoperative resources. Overscreening leads to greater delay to surgery, which poses a risk for perioperative complications and early mortality. Level of evidence II.

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Effect of Preoperative Transthoracic Echocardiogram on Mortality and Surgical Timing in Elderly Adults with Hip Fracture

Cited by 28 publications

References 22 publications

Association between Preoperative Transthoracic Echocardiography and Clinical Outcomes after Scheduled Hip Fracture Surgery in Geriatric Patients

Association between Preoperative Transthoracic Echocardiography and Clinical Outcomes after Scheduled Hip Fracture Surgery in Geriatric Patients

Clinical guidelines reduce unnecessary preoperative echocardiograph in elderly hip fracture patients

Cardiac overscreening hip fracture patients

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