ABSTRACT
Introduction:
Delay to
surgery >24 hours has been shown to correlate with
mortality rates in
patients with
hip fracture when left untreated. Many of these
patients have multiple comorbidities, including
aortic stenosis (AS), and undergo workup for operative clearance, which may delay
time to
surgery. The purpose of this study was to examine whether preoperative echocardiogram workup
affects time to
surgery,
complications, and
mortality after operative fixation for
hip fracture.
Methods:
Our institutional
hip fracture
registry was retrospectively reviewed for inclusion over a 3-year period.
Patients who had a preoperative echocardiogram (yECHO) for operative clearance were compared with those
who did not (nECHO).
Demographic data,
time to
surgery, overall complication rate, and
mortality at 30 days, 90 days, and 1 year were collected.
Results:
Two cohorts consisted of 136 yECHO
patients (45.8%) and 161 nECHO
patients (54.2%). Thirty-two yECHO
patients (23.5%) had AS.
Patients in the yECHO cohort were more likely to have a complication for any cause compared with nECHO
patients (25.7% vs. 10.6%, P = 0.01) and have a higher mortality rate at 1 year (38.9% vs. 17.4%, P = 0.001). There was no
association found between AS and all-cause complication (P = 0.54) or 30-day (P = 0.13) or 90-day
mortality rates (P = 0.79). However,
patients with AS had a significantly higher mortality rate at 1 year (45.8% vs. 25.1%, P = 0.03).
Conclusion:
This study reinforces the benefits of ensuring less than a 24-hour
time to
surgery in the setting of a
hip fracture and identifies an area of preoperative management that can be further optimized to prevent unnecessary prolongation in
time to
surgery.
Patients with known
aortic stenosis are not associated with increased 30-day or 90-day
mortality or all-cause
complications. Surgical delays in the yECHO cohort were attributed to preoperative medical assessments, including echocardiograms and the management of comorbidities. Therefore, the selective utilization of preoperative echocardiograms is needed and should be reserved to ensure they have a definitive
role in guiding the
perioperative care of
patients with
hip fracture. Level of Evidence III.
