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Noninvasive Determination of Vortex Formation Time Using Transesophageal Echocardiography During Cardiac Surgery
Published on: November 28, 2018
Preoperative echocardiogram does not increase time to surgery in hip fracture patients with prior percutaneous
Tensae Assefa1, Garrett Esper2, Salvatore Cavaleri3
1NYU Grossman School of Medicine, 550 1st Ave, New York, NY, 10016, USA.
Insights
Preoperative echocardiograms do not change surgery times for hip fracture patients. However, for patients with a history of percutaneous coronary intervention (PCI), a preoperative transthoracic echocardiogram (TTE) may be associated with worse outcomes.
Area of Science:
- Cardiology
- Orthopedic Surgery
- Geriatric Medicine
Background:
- Hip fracture patients often have comorbidities, including history of percutaneous coronary intervention (PCI).
- Preoperative cardiac evaluation, such as transthoracic echocardiogram (TTE), is common in this population.
- The impact of TTE on surgical timing and patient outcomes in hip fracture patients with PCI history is not well-defined.
Purpose of the Study:
- To evaluate the effect of preoperative TTE on time to surgery in hip fracture patients.
- To assess the outcomes of hip fracture patients with a history of PCI, comparing those who received a preoperative TTE versus those who did not.
Main Methods:
- Retrospective analysis of consecutive hip fracture patients (2014-2020).
- Data collected included demographics, clinical factors, quality metrics, and costs.
- Patients were stratified based on preoperative TTE and PCI history.
- Comparative analyses were performed using the STTGMA risk predictive tool.
Main Results:
- Preoperative TTE did not significantly alter time to surgery or 30-day mortality for hip fracture patients, irrespective of PCI history.
- Hip fracture patients with PCI history who underwent preoperative TTE showed increased 1-year mortality and major complications compared to those without PCI history.
- Patients receiving preoperative TTE had higher 90-day readmission rates and 1-year mortality compared to those without TTE.
Conclusions:
- Preoperative TTE does not impact surgical wait times for hip fracture patients, regardless of PCI history.
- Preoperative TTE may not improve mortality or reduce postoperative complications in patients with a history of PCI.
- Further research is needed to clarify the role and benefits of preoperative TTE in specific high-risk hip fracture populations.
Background:
The purpose of this study was to (1) assess the effect of preoperative echocardiogram on time to surgery and (2) assess the outcomes of patients with a previous percutaneous coronary intervention (PCI).
Methods:
Demographic, clinical, quality and cost data were obtained and a validated risk predictive tool (STTGMA) was calculated for each of a consecutive series of hip fracture patients. Comparative analyses of patients who had an echocardiogram prior to surgery or a PCI prior to hospitalization were performed.
Results:
Between 2014 and 2020, 2625 patients presented to our institution with a hip fracture. From this cohort 471 patients underwent a preoperative transthoracic echocardiogram (TTE), 30 who had a history of a PCI, and an additional 26 who had a history of PCI but did not undergo a preoperative TTE. Those undergoing a preoperative TTE had similar time (days) to surgery (1.73 vs 1.77, p = 0.86) and 30-day mortality (4% vs 7%, p = 0.545) regardless of PCI history. PCI patients who underwent a preoperative TTE experienced increased rates of 1-year mortality (27% vs 10%, p = 0.007) and major complications (23% vs 12%, p = 0.08) compared to those without a PCI history. PCI patients undergoing a preoperative TTE had a similar time (days) to surgery (1.77 vs 1.48, .p = 0.397) compared to PCI patients without a preoperative TTE. Patients who underwent a preoperative TTE had higher rates of 90-day readmission (31.0% vs 8.0%, p = 0.047) and 1-year mortality (26.7% vs 3.8%, p = 0.029).
Conclusions:
Having a preoperative TTE does not affect surgical wait times in hip fracture patients regardless of PCI history, but it may not improve mortality outcomes or reduce postoperative complications in patients with a history of a PCI.
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