Preoperative Echocardiography for Patients With Hip Fractures Undergoing Surgery: A Retrospective Cohort Study Using a Nationwide Database

Abstract

BACKGROUND: The effect of preoperative transthoracic echocardiography on the clinical outcomes of patients with hip fractures undergoing surgical treatment remains controversial. We hypothesized that preoperative echocardiography is associated with reduced postoperative morbidity and improved patient survival after surgical repair of hip fractures. METHODS: Drawing from a nationwide administrative database, patients undergoing hip fracture surgeries between April 1, 2008 and December 31, 2016 were included. We examined the association of preoperative echocardiography with the incidence of in-hospital mortality using propensity score matching. Secondary outcomes included postoperative complications, the incidence of postoperative intensive care unit admissions, and length of hospital stay. For sensitivity analyses, we restricted the overall cohort to include only hip fracture surgeries performed within 2 days from admission. RESULTS: Overall, 34,679 (52.1%) of 66,620 surgical patients underwent preoperative echocardiography screening. The screened patients (mean [SD] age, 84.3 years [7.7 years]; 79.0% female) were propensity score matched to 31,941 nonscreened patients (mean [SD] age, 82.1 years [8.7 years]; 78.2% female). The overall in-hospital mortality, before propensity matching, was 1.8% (1227 patients). Propensity score matching created a matched cohort of 25,205 pairs of patients. There were no in-hospital mortality differences between the 2 groups (screened versus nonscreened: 417 [1.65%] vs 439 [1.74%]; odds ratio, 0.95; 95% confidence interval, 0.83–1.09; P = .45). Preoperative echocardiography was not associated with reduced postoperative complications and intensive care unit admissions. In sensitivity analysis, we identified 25,637 patients from the overall cohort (38.5%) with hip fracture surgeries performed within 2 days of admission. There were no in-hospital mortality differences between the 2 groups (screened versus nonscreened: 1.67% vs 1.80%; odds ratio, 0.93; 95% confidence interval, 0.72–1.18; P = .53). Findings were also consistent with other sensitivity analyses and subgroup analyses. CONCLUSIONS: This large, retrospective, nationwide cohort study demonstrated that preoperative echocardiography was not associated with reduced in-hospital mortality or postoperative complications.

<p>Prediction of Early Postoperative Major Cardiac Events and In-Hospital Mortality in Elderly Hip Fracture Patients: The Role of Different Types of Preoperative Cardiac Abnormalities on Echocardiography Report</p>

“…24 The in-hospital mortality rate was 2.8% in our study, which is in agreement with a previous study result. 25 Both AS and LVEF <50% were independent predictors of inhospital mortality. AS was established as an important factor that was associated with higher mortality in previous studies.…”

Guideline for the management of hip fractures 2020

“…Several studies since 2011 have provided conflicting results on outcome benefits and treatment decisions after pre‐operative (focused) transthoracic echocardiography in hip fracture patients [54–56]. Group separation in a recent pilot study suggests that a larger, multicentre RCT comparing mortality/composite outcomes after focused echocardiography is feasible [57, 58].…”

Adverse outcomes after noncardiac surgery in patients with aortic stenosis

“…Current guidelines recommend that preoperative echocardiography be performed for patients with clinically suspected moderate or severe valvular stenosis or regurgitation 4 , 5 ; however, the necessity of preoperative echocardiography in patients with high cardiac risk is still a matter of debate. A recent study reported that heart failure defined by left ventricular ejection fraction < 50% was significantly associated with 90-day mortality after noncardiac surgery regardless of clinical symptoms 38 ; however, another study reported that preoperative echocardiography was not linked to decreased postoperative complications or in-hospital mortality after hip fracture surgery 39 . Randomized trials are needed to assess the potential benefits of preoperative echocardiography in high-risk patients.…”