Elevated right ventricular systolic pressure and outcomes after emergency hip surgery: a case control study

Patients at risk of pulmonary hypertension frequently present for emergency orthopedic surgery. A right ventricular systolic pressure of 35 mmHg or above, calculated from a tricuspid regurgitant jet on transthoracic echocardiogram, is considered an appropriate screening test for pulmonary hypertension. The aim of this study was to evaluate the impact of an elevated right ventricular systolic pressure detected on a preoperative transthoracic echocardiogram, on outcomes after emergency hip surgery. We undertook a retrospective, single centre, case control study of 98 adult patients who had a transthoracic echocardiogram before undergoing emergency hip surgery over a six-year period. Forty-two of the 98 patients (43%) had an elevated right ventricular systolic pressure (≥ 35mmHg) and 56 patients (57%) had a normal right ventricular systolic pressure (< 35mmHg) on preoperative echocardiography. All in-hospital deaths in our study occurred in the elevated right ventricular systolic pressure group (8/42 (19%) vs. 0/56 (0%), p = < 0.001). Three patients died within one week of surgery after a cardiac arrest. The remaining 5 patients died a median of 26 (IQR 24-59) days after surgery due to pneumonia and progression of comorbid disease. Patients with an elevated right ventricular systolic pressure were older and had a higher prevalence of atrial fibrillation. In multiple logistic regression analysis, there was no association between either of these variables and survival to hospital discharge. There was a greater number of patients with heart failure, ischaemic heart disease and chronic obstructive pulmonary disease in the elevated right ventricular systolic pressure group, however the differences between the two groups did not reach statistical significance. This study highlights an association between elevated preoperative right ventricular systolic pressure and increased mortality after emergency hip surgery. Elevated right ventricular systolic pressure could be indicative of pulmonary hypertension or be secondary to underlying heart or lung disease. Irrespective of the exact cause of raised right ventricular systolic pressure, the association with increased in hospital mortality warrants further investigation.