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Preoperative Workup of Operative Hip Fracture Patients: A Survey
Garrett W Esper1, Utkarsh Anil1, Salvatore G Cavaleri2
1Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA.
Insights
Physician agreement on cardiac screening for elderly hip fracture patients is low between specialties. This highlights the need for standardized preoperative workup protocols to improve patient care.
Area of Science:
- Geriatric Medicine
- Cardiology
- Orthopedic Surgery
- Anesthesiology
Background:
- Disagreement exists among healthcare providers regarding the necessity of preoperative cardiac screening for elderly patients with hip fractures.
- Assessing cardiovascular risk is crucial for optimizing preoperative care in this patient population.
Purpose of the Study:
- To evaluate physician perceptions of preoperative workup for hip fracture patients across different medical specialties.
- To specifically examine how cardiovascular risk influences these perceptions.
Main Methods:
- A case-based survey was administered to physicians in orthopedic surgery, anesthesiology, cardiology, and hospital medicine.
- The survey assessed criteria for cardiology consultations and requirements for preoperative imaging and laboratory tests.
- Intraclass correlation coefficients (ICCs) were used to measure inter-specialty and intra-specialty agreement.
Main Results:
- A low response rate of 16.5% was observed (33 out of 200 physicians).
- Overall agreement on the need for cardiology consultation was 72% (ICC = 0.063, poor).
- Agreement on the need for preoperative transthoracic echocardiogram (TTE) was 71% (ICC = 0.188, poor).
- Intra-specialty agreement varied, with anesthesiology and cardiology showing good agreement for cardiology consults, while hospital medicine and orthopedic surgery showed poor agreement.
- Intra-specialty agreement for TTE was good in anesthesiology and hospital medicine, but poor in cardiology and orthopedic surgery.
Conclusions:
- Significant disparities in agreement exist between specialties regarding the necessity of cardiology consultations and preoperative imaging for hip fracture patients.
- The findings suggest a need for developing standardized, evidence-based preoperative workup protocols involving multidisciplinary input.
- Implementing consistent protocols can streamline preoperative care and potentially improve outcomes for elderly hip fracture patients.
Abstract:
Background: There may be disagreement among stakeholders on the need for preoperative cardiac screening for elderly hip fracture patients. Purpose: We sought to assess preoperative workup perceptions among physicians for hip fracture patients across specialties, specifically considering a patient's cardiovascular risk. Methods: A case-based survey was distributed to 50 physicians in each of the 4 departments involved in preoperative patient care: orthopedic surgery (OS), anesthesiology (A), cardiology (C), and hospital medicine (HM). The survey asked about which clinical presentations required a cardiology consult, as well as about further preoperative imaging and laboratory work. Single score intraclass correlation coefficient (ICC) was used to compare agreement. Results: Of the 200 surveys sent out, 33 responses (16.5% response rate) were received. Between all specialties, there was 72% agreement about preoperative cardiology consult need (intraclass correlation coefficient [ICC] = 0.063 or poor) and 71% agreement about preoperative transthoracic echocardiogram (TTE) need (ICC = 0.188 or poor). Within each specialty (A, C, HM, OS) ICCs measuring agreement for the need for cardiology consult were 0.812 (good), 0.561 (moderate), 0.457 (poor), and 0.414 (poor), respectively, and for the need for preoperative TTE were 0.852 (good), 0.441 (poor), 0.848 (good), and 0.188 (poor), respectively. Common preoperative testing requested included complete blood count, basic metabolic panel in all cases, and electrocardiogram with troponins if perioperative acute coronary syndrome symptoms were present. Conclusion: This survey suggests that there may be varying levels of agreement within specialties and poor agreement between specialties on the need for cardiology consultation and preoperative imaging for hip fracture patients. This suggests the need for established, reliable preoperative workup protocols with input from different specialties to streamline preoperative care for patients before hip fracture surgery.
