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Preoperative transthoracic echocardiogram and delay to geriatric hip fracture surgery
Introduction:
Delays to surgery confer increased morbidity and mortality in elderly patients who have sustained hip fractures. Preoperative investigations including transthoracic echocardiography (TTE) are often requested. The aim of this study was to determine whether there were delays to surgery when these patients underwent preoperative TTE.
Methods:
Electronic databases were searched from inception until April 2025. All relevant studies were identified with data extracted and meta-analysed.
Findings:
A total cohort of 2,581 patients was extracted from 5 studies; 865 (34%) patients received a preoperative TTE, and 1,716 (66%) patients did not. Baseline characteristics of age, sex, fracture pattern and treatment were similar. Patients receiving a preoperative TTE were more likely to have coronary artery disease (CAD), congestive cardiac failure (CCF) and arrythmia. The mean time to surgery was 9.4h (p = 0.09) shorter in the group not receiving a TTE. The mean length of hospital stay was 0.6 days (p = 0.03) shorter in those who did not receive a preoperative TTE.
Conclusions:
The available evidence did not demonstrate a statistically significant association between time to surgery and preoperative TTE. However, the data available are limited by heterogeneity, confounding and insufficient statistical power. In general, improving access to, and efficiency in TTE could help minimise delays to surgery, particularly in centres with limited resources. Strict adherence to American College of Cardiology guidelines for preoperative TTE indications is recommended.
