Cardiac overscreening hip fracture patients

Abstract

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.

Factors That Influence Time to Operating Room for Geriatric Hip Fractures: A Quality Improvement Initiative

“…Smeets et al. examined the adherence to these guidelines in a prospective cohort study [ 14 ]. They found that 87% of patients received the correct screening, with “overscreening” being the predominant reason for incorrect screening [ 14 ].…”

“…examined the adherence to these guidelines in a prospective cohort study [ 14 ]. They found that 87% of patients received the correct screening, with “overscreening” being the predominant reason for incorrect screening [ 14 ]. A larger retrospective study found that only 29% of the patients with cardiac consultations met the guidelines [ 15 ].…”

Fractional spinal anesthesia and systemic hemodynamics in frail elderly hip fracture patients

“…Many factors affect the mortality, some of those are time to start-of-surgery [2], cementation of hemi-or total arthroplasty [3], and preoperative morbidity assessed by American Society of Anaesthesiologist (ASA) risk score and Nottingham Hip Fracture Score (NHFS) [4,5]. Preoperative cardiology consulting, however, rarely affects surgical management, but could alter anesthesiologic management [6].…”

Fractional spinal anesthesia and systemic hemodynamics in frail elderly hip fracture patients

“…6,7 Preoperative cardiology consulting, however, rarely affects surgical management, but could alter anesthesiologic management. 8 The peri-operative anaesthesia strategy for the management of the frail hip fracture patient differs worldwide: where many centers give general anaesthesia, while particularly in northern Europe, neuraxial anaesthesia is the preferred technique. However, both techniques frequently induce hypotension, requiring fluid resuscitation and/or the need for vasopressors.…”