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Preoperative cardiac evaluation of geriatric patients with hip fracture
S J M Smeets1, M Poeze, J P A M Verbruggen
1Department of Surgery, Maastricht University Medical Center, Postbus 5800, 6202 AZ Maastricht, The Netherlands. s.smeets@mmc.nl
Insights
Preoperative cardiac evaluation for hip fracture patients is often unnecessary, particularly in intermediate-risk groups, leading to delayed surgery. Adhering to ACC/AHA guidelines can optimize care and reduce complications.
Area of Science:
- Cardiology
- Geriatric Medicine
- Trauma Surgery
Background:
- Established ACC/AHA guidelines exist for perioperative cardiac assessment in non-cardiac surgery.
- Geriatric patients with hip fractures require careful preoperative evaluation.
Purpose of the Study:
- To assess adherence to ACC/AHA guidelines for preoperative cardiac evaluation in hip fracture patients.
- To determine the impact of guideline adherence on surgical delay, complications, and mortality.
Main Methods:
- Retrospective analysis of 388 hip fracture patients (2003-2006) with 2-year follow-up.
- Evaluation of preoperative cardiac screening content against ACC/AHA guidelines.
- Correlation of screening compliance with risk stratification (low, intermediate, high) and outcomes.
Main Results:
- 82% low, 46% intermediate, and 86% high-risk patients received correct preoperative cardiac screening.
- Overscreening was common (>95%) and increased surgical delay by 9.9 hours (p=0.03).
- Delay >48 hours correlated with increased cardiovascular complications and mortality.
Conclusions:
- Preoperative cardiac screening is frequently excessive in hip fracture patients, especially intermediate-risk cases, causing delays.
- Implementing ACC/AHA guidelines can reduce unnecessary consultations, shorten surgical delays, and potentially decrease postoperative complications.
Background:
The American College of Cardiology (ACC) and the American Heart Association (AHA) have developed guidelines for perioperative assessment of patients in case of non-cardiac surgery. The aim of this study was to investigate if the preoperative cardiac evaluation of geriatric patients with hip fracture was in accordance with these guidelines and what the effects were on outcome.
Methods:
In a retrospective study 388 patients with hip fracture treated in the department of Trauma surgery of the Maastricht University Medical Centre in the Netherlands were included. All patients were treated between 2003 and 2006 and had at least two year follow-up. The preoperative cardiac screening was analysed with respect to content and to which level this followed the ACC/AHA guidelines. These guidelines were used to classify cardiac risk into low, intermediate and high risk. This was related to the outcome measurements delay to surgery, perioperative complications and mortality.
Results:
According to the ACC/AHA guidelines 82% of patients received correct preoperative cardiac screening in the low vs. 46% in the intermediate and 86% in the high risk group. The most frequent reason for incorrect preoperative cardiac screening was overscreening (>95%). The delay to surgery increased by 9.9h in the case of overscreening (p=0.03). A previous cardiac history was a significant risk factor for early mortality. Delay of >48 h was associated with more cardiovascular complications and mortality both on univariate and multivariate analysis.
Conclusion:
Preoperative cardiac screening is frequently unnecessary after hip fracture, especially in patients with intermediate risk predictors and increases the delay to surgery. Delay of >48 h was associated with more cardiovascular complications and mortality postoperatively. The implementation of the ACC/AHA guidelines may prevent unnecessary cardiac consultations which reduces preoperative resources, delay to surgery and possibly decreases postoperative complications.
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