How do preoperative echocardiograms in geriatric hip fracture patients affect care? A matched cohort study

Area of Science:

• Geriatric Trauma Surgery
• Cardiology
• Perioperative Medicine

Background:

• Hip fractures are common in the elderly, necessitating timely surgery.
• Balancing early surgical intervention with medical optimization is challenging.
• Preoperative transthoracic echocardiography (TTE) may delay hip fracture surgery, but its indications are often unclear.

Purpose of the Study:

• To determine the proportion of preoperative TTEs indicated for geriatric hip fracture patients based on established guidelines.
• To assess the impact of TTE on perioperative management, surgical timing, and patient outcomes.

Main Methods:

• Retrospective case-control study of 113 geriatric hip fracture patients who underwent preoperative TTE.
• Matched comparison group of 113 hip fracture patients who did not undergo TTE.
• Analysis of TTE indications, perioperative management changes, time to surgery, length of stay, and mortality.

Main Results:

• 71.7% of preoperative TTEs were indicated per guidelines.
• TTE was associated with increased use of arterial and central lines.
• TTE group experienced longer time to surgery (44.8 vs. 24.2 hours) and longer length of stay (7 vs. 5 days).
• Higher 90-day mortality was observed in the TTE group (OR 4.4), but no difference at 2 years.

Conclusions:

• Preoperative TTE in geriatric hip fracture patients is linked to surgical delays and increased short-term mortality.
• Despite many TTEs being indicated, they impact perioperative management and outcomes.
• Emphasizes the need for efficient preoperative assessment in geriatric hip fracture patients.