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Archives of Orthopaedic and Trauma Surgery

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Open Access 01-01-2020 | Transthoracic Echocardiography | Trauma Surgery

Cardiac overscreening hip fracture patients

Authors: S. J. M. Smeets, B. P. W. van Wunnik, M. Poeze, G. D. Slooter, J. P. A. M. Verbruggen

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 1/2020

Abstract

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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Title: Cardiac overscreening hip fracture patients
Authors: S. J. M. Smeets
B. P. W. van Wunnik
M. Poeze
G. D. Slooter
J. P. A. M. Verbruggen
Publication date: 01-01-2020
Publisher: Springer Berlin Heidelberg
Keyword: Transthoracic Echocardiography
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 1/2020
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-019-03270-z

At a glance: The STEP trials

Springer Medicine

Cardiac overscreening hip fracture patients

Abstract

Background

Methods

Results

Conclusion

Level of evidence

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Level of evidence

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