Hip fracture in the elderly patient: Is the preoperative echocardiogram necessary?
Abstract
Introduction: Hip fractures frequently occur in elderly patients with multiple medical comorbidities. The transthoracic echocardiogram (TTE) is often performed as part of the preoperative evaluation. The main purpose of this study was to assess the impact on surgical delay of preoperative TTE in hip fracture inpatients. Materials and Methods: We performed a retrospective study in 40 hip fracture patients who underwent TTE during the preoperative evaluation. The control group was made up of 70 patients of similar ages and comorbidities (P>0,05). We studied the surgical delay, the guideline adherence rate (ACC/AHA), and the impact on perioperative management. Results: The surgical delay was longer in the TTE group (P<0.01), the guideline adherence rate was 47.5% and the examination did not generate any changes in the perioperative management in 97.5% of the patients. Conclusion: The request for the inpatient echocardiogram generates additional preoperative delays. Approximately half of our series was considered excessive TTE testing, which increases costs, and in patients in whom it is not indicated, TTE does not generate any changes in the perioperative management. Level of Evidence: IVDownloads
References
Sawhney C, Trikha V, Janani S, Bajwa SJS, Sharma V, Khanna M. Impact of preoperative echocardiography on perioperative management in geriatric hip trauma: a retrospective observational study. Int J Appl Basic Med Res 2017;7(2):104-7. https://doi.org/10.4103/2229-516X.205816
Adair C, Swart E, Seymour R, Patt J, Karunakar MA. Clinical Practice Guidelines Decrease Unnecessary
Echocardiograms Before Hip Fracture Surgery. J Bone Joint Surg Am 2017;99:676-80. https://doi.org/10.2106/
JBJS.16.01108
Casaletto J,A Gatt R. Post-operative mortality related to waiting time for hip fracture surgery. Injury 2004;35:114-20. https://doi.org/10.1016/s0020-1383(03)00210-9
Lefaivre KA, Macadam SA, Davidson DJ, Gandhi R, Chan H, Broekhuyse HM. Length of stay, mortality, morbidity and delay to surgery in hip fractures. J Bone Joint Surg Br 2009;91(7):922-7. https://doi.org/10.1302/0301-620X.91B7.22446
Zuckerman JD. Hip fracture. New Engl J Med 1996;334:1519-25. https://doi.org/10.1056/NEJM199606063342307
Jain R, Basinski A, Kreder HJ. Nonoperative treatment of hip fractures. Int Orthop 2003;27(1):11-17. https://doi.
org/10.1007/s00264-002-0404-y
Ricci WM, Della Rocca GJ, Combs C, Borrelli J. The medical and economic impact of preoperative cardiac testing in elderly patients with hip fractures. Injury 2007;38 Suppl 3:S49-52. https://doi.org/10.1016/j.injury.2007.08.011
Sherk HH, Snape WJ, Loprete FL. Internal fixation versus nontreatment of hip fractures in senile patients. Clin
Orthop 1979;141:196-8. PMID: 477105
Morrison RS, Chassin MR, Siu AL. The medical consultant’s role in caring for patients with hip fracture. Ann Intern Med 1998;128(12 Pt 1):1010-20. https://doi.org/10.7326/0003-4819-128-12_part_1-199806150-00010
Fleisher LA, Fleischmann KE, Auerbach AD, Barnason SA, Beckman JA, Bozkurt B, et al.; American College of
Cardiology; American Heart Association. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation
and management of patients undergoing noncardiac surgery: a report of the American College of Cardiology/
American Heart Association Task Force on practice guidelines. J Am Coll Cardiol 2014;64(22):e77-137. https://doi.
org/10.1016/j.jacc.2014.07.944
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in
longitudinal studies: development and validation. J Chronic Dis 1987;40(5):373-83. https://doi.org/10.1016/0021-
(87)90171-8
Charlson ME, Charlson RE, Paterson JC, Marinopoulos SS, Briggs WM, Hollenberg JP. The Charlson comorbidity index is adapted to predict costs of chronic disease in primary care patients. J Clin Epidemiol 2008;61(12): 1234-40. https://doi.org/10.1016/j.jclinepi.2008.01.006
Grimes JP, Gregory PM, Noveck H, Butler MS, Carson JL. The effects of time-to-surgery on mortality and
morbidity in patients following hip fracture. Am J Med 2002;112(9):702-9. https://doi.org/10.1016/s0002-
(02)01119-1
Al-Ani AN, Samuelsson B, Tidermark J, Norling A, Ekström W, Cederholm T, et al. Early operation on patients
with a hip fracture improved the ability to return to independent living. A prospective study of 850 patients. J Bone Joint Surg Am 2008;90:1436-42. https://doi.org/10.2106/JBJS.G.00890
Orosz GM, Magaziner J, Hannan EL, Morrison RS, Koval K, Gilbert M, et al. Association of timing of surgery for
hip fracture and patient outcomes. JAMA 2004;291:738-43. https://doi.org/10.1001/jama.291.14.1738
Murry J, Truitt MS, Mani U, Patel N, Aramoonie A, Dunn EL. Have echocardiograms affected recommended therapy in geriatric trauma patients. J Trauma Nurs 2014;21(4):150-2. https://doi.org/10.1097/JTN.0000000000000056
Marcantonio A, Steen B, Kain M, Bramlett KJ, Tilzey JF, Iorio R. The clinical and economic impact of preoperative transthoracic echocardiography in elderly patients with hip fractures. Bull Hosp Jt Dis 2015;73(4):239-42. PMID: 26630466
Luttrell K, Nana A. Effect of preoperative transthoracic echocardiogram on mortality and surgical timing in elderly adults with hip fracture. J Am Geriatr Soc 2015;63(12):2505-9. https://doi.org/10.1111/jgs.13840
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