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Method and Instrumented Fixture for Femoral Fracture Testing in a Sideways Fall-on-the-Hip Position
Published on: August 17, 2017
Cardiac overscreening hip fracture patients
S J M Smeets1, B P W van Wunnik2, M Poeze3
1Department of Surgery, Flevoziekenhuis, Hospitaalweg 1, 1315 RA, Almere, The Netherlands. ssmeets@flevoziekenhuis.nl.
Insights
Adherence to cardiac screening guidelines for hip fracture patients reduces resource use. However, overscreening delays surgery, increasing mortality risk and complications.
Area of Science:
- Cardiology
- Geriatric Medicine
- Orthopedic Surgery
Background:
- Hip fracture patients require careful perioperative assessment.
- Adherence to American College of Cardiology (ACC) and American Heart Association (AHA) guidelines is crucial for patient outcomes.
- Current clinical practice for perioperative cardiac assessment in hip fracture patients needs investigation.
Purpose of the Study:
- To prospectively evaluate adherence to ACC/AHA guidelines for perioperative cardiac assessment in hip fracture patients.
- To determine the impact of guideline adherence on patient outcomes.
- To analyze factors influencing preoperative cardiac screening and surgical delay.
Main Methods:
- Prospective cohort study of 166 hip fracture patients over 3 years.
- Analysis of preoperative cardiac screening and ACC/AHA guideline adherence.
- Classification of cardiac risk (low, intermediate, high).
- Secondary outcomes included surgical delay, complications, and mortality at various time points.
Main Results:
- 87% of patients received correct preoperative cardiac screening per ACC/AHA guidelines.
- Overscreening (> 90%) was the primary reason for incorrect screening.
- Cardiac consultation and overscreening significantly predicted increased surgical delay.
- High-risk patients had higher in-hospital mortality compared to low-risk patients.
- Previous cardiac history and surgical delay predicted early mortality; high age and cardiac history predicted late mortality.
Conclusions:
- Adherence to ACC/AHA guidelines for preoperative cardiac screening in hip fracture patients is linked to reduced preoperative resource utilization.
- Overscreening contributes to surgical delays, elevating the risk of perioperative complications and early mortality.
- Optimizing cardiac screening protocols can improve patient outcomes and resource management.
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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