Effect of Heart Failure With Preserved Ejection Fraction on Perioperative Outcomes in Patients Undergoing Hip Fracture Surgery

Bohsali, Fuad; Klimpl, David; Baumgartner, Rita; Sieber, Frederick E.; Eid, Shaker M.

doi:10.5435/jaaos-d-18-00731

Cited by 13 publications

(7 citation statements)

References 34 publications

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“…This included, pre-, peri-and post-operative events (up to 6 months post-surgery). This is slightly higher than a large study looking at over two million hip fracture operations, which quotes a total number of adverse cardiovascular events to be at 3.3% [29]. However, this study only investigated peri-operative events and may have underestimated the risk because of "under-coding" of these conditions.…”

Section: Discussionmentioning

confidence: 82%

Mortality and Medical Complications of Subtrochanteric Fracture Fixation

Panteli

Giannoudi

Lodge

et al. 2021

JCM

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The aim of this study was to define the incidence and investigate the associations with mortality and medical complications, in patients presenting with subtrochanteric femoral fractures subsequently treated with an intramedullary nail, with a special reference to advancement of age. Materials and Methods: A retrospective review, covering an 8-year period, of all patients admitted to a Level 1 Trauma Centre with the diagnosis of subtrochanteric fractures was conducted. Normality was assessed for the data variables to determine the further use of parametric or non-parametric tests. Logistic regression analysis was then performed to identify the most important associations for each event. A p-value < 0.05 was considered significant. Results: A total of 519 patients were included in our study (age at time of injury: 73.26 ± 19.47 years; 318 female). The average length of hospital stay was 21.4 ± 19.45 days. Mortality was 5.4% and 17.3% for 30 days and one year, respectively. Risk factors for one-year mortality included: Low albumin on admission (Odds ratio (OR) 4.82; 95% Confidence interval (95%CI) 2.08–11.19), dementia (OR 3.99; 95%CI 2.27–7.01), presence of pneumonia during hospital stay (OR 3.18; 95%CI 1.76–5.77) and Charlson comorbidity score (CCS) > 6 (OR 2.94; 95%CI 1.62–5.35). Regarding the medical complications following the operative management of subtrochanteric fractures, the overall incidence of hospital acquired pneumonia (HAP) was 18.3%. Patients with increasing CCS (CCS 6–8: OR 1.69; 95%CI 1.00–2.84/CCS > 8: OR 2.02; 95%CI 1.03–3.95), presence of asthma/chronic obstructive pulmonary disease (COPD) (OR 2.29; 95%CI 1.37–3.82), intensive care unit (ICU)/high dependency unit (HDU) stay (OR 3.25; 95%CI 1.77–5.96) and a length of stay of more than 21 days (OR 8.82; 95%CI 1.18–65.80) were at increased risk of this outcome. The incidence of post-operative delirium was found to be 10.2%. This was associated with pre-existing dementia (OR 4.03; 95%CI 0.34–4.16), urinary tract infection (UTI) (OR 3.85; 95%CI 1.96–7.56), need for an increased level of care (OR 3.16; 95%CI 1.38–7.25), pneumonia (OR 2.29; 95%CI 1.14–4.62) and post-operative deterioration of renal function (OR 2.21; 95%CI 1.18–4.15). The incidence of venous thromboembolism (VTE) was 3.7% (pulmonary embolism (PE): 8 patients; deep venous thrombosis (DVT): 11 patients), whilst the incidence of myocardial infarction (MI)/cerebrovascular accidents (CVA) was 4.0%. No evidence of the so called “weekend effect” was identified on both morbidity and mortality. Regression analysis of these complications did not reveal any significant associations. Conclusions: Our study has opened the field for the investigation of medical complications within the subtrochanteric fracture population. Early identification of the associations of these complications could help prognostication for those who are at risk of a poor outcome. Furthermore, these could be potential “warning shots” for clinicians to act early to manage and in some cases prevent these devastating complications that could potentially lead to an increased risk of mortality.

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Section: Discussionmentioning

confidence: 82%

Mortality and Medical Complications of Subtrochanteric Fracture Fixation

Panteli

Giannoudi

Lodge

et al. 2021

JCM

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“…26 However, to our knowledge, only few studies have reported the association between LVEF and postoperative outcome in elderly hip fracture. 27,28 A recent study based on national database involving 2,020,712 patients, demonstrated that LVEF <50% increased the rate of postoperative adverse events such as in-hospital all-cause death, in-hospital cardiac arrest or acute ischemic stroke. 27 However, another study involving 181 patients diagnosed with intertrochanteric fracture (only 65 had preoperative TTE) did not show the association between low LVEF and mortality.…”

Section: Discussionmentioning

confidence: 99%

“…27,28 A recent study based on national database involving 2,020,712 patients, demonstrated that LVEF <50% increased the rate of postoperative adverse events such as in-hospital all-cause death, in-hospital cardiac arrest or acute ischemic stroke. 27 However, another study involving 181 patients diagnosed with intertrochanteric fracture (only 65 had preoperative TTE) did not show the association between low LVEF and mortality. 28 One explanation for this was that their study only included patients with intertrochanteric fracture, which had different baseline demographic characteristics compared with our study.…”

Section: Discussionmentioning

confidence: 99%

<p>Prediction of Early Postoperative Major Cardiac Events and In-Hospital Mortality in Elderly Hip Fracture Patients: The Role of Different Types of Preoperative Cardiac Abnormalities on Echocardiography Report</p>

Chen¹,

Ma²,

Deng³

et al. 2020

CIA

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Introduction: Transthoracic echocardiography (TTE) is a common cardiac screening test before hip fracture surgery. However, the general TTE test delays surgery, so it would be meaningful if we could simplify the TTE by only assessing cardiac abnormality specifically. Therefore, we aimed to establish the most clinically relevant abnormality by comparing the predictive value of each major cardiac abnormality in postoperative cardiac complications and mortality in elderly hip fracture patients. Patients and Methods: From January 2014 to January 2019, the medical records of all surgically treated elderly patients (>65 years) with hip fracture were analyzed. The major TTE abnormalities were defined as left ventricular hypertrophy, systolic pulmonary arterial pressure >25 mm Hg, moderate-severe valve abnormality, left ventricular ejection fraction (LVEF) <50%, and pericardial effusion. The outcomes were postoperative cardiac complications and in-hospital mortality. Results: There were 354 patients involved finally. Postoperative cardiac complications were encountered in 7.6% (n=27) of patients. The mortality rate was 2.8% (n=10). History of coronary artery disease (CAD) (OR: 3.281, 95% CI: 1.332-8.079, p=0.010) and presence of aortic stenosis (AS) (OR:5.656, 95% CI: 1.869-17.117, p=0.002) were independent predictors of postoperative cardiac complications.

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“…12 Systolic or diastolic heart failure has been closely linked to the major adverse cardiac events and in-hospital mortality in these patients. 13 – 15 However, the current data is lacking about in-hospital mortality predictors in patients without heart failure. Hence, identifying the other possible preoperative cardiac risk factors causing high mortality and morbidity is crucial for implementing the treatment strategies in hip fracture patients treated with surgery.…”

Section: Discussionmentioning

confidence: 99%

Preoperative cardiac risk factors associated with in-hospital mortality in elderly patients without heart failure undergoing hip fracture surgery: a single-centre study

Çiçek

Çınar

Hayıroğlu³

et al. 2020

Postgraduate Medical Journal

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IntroductionIn the present study, our aim was to ascertain the preoperative cardiac risk factors related to the in-hospital mortality in the elderly patients (aged over 65 years) who required preoperative cardiology consultation for hip fracture surgery.Material and MethodsThe present study was a retrospective, single-centre study, which enrolled consecutive elderly patients without heart failure scheduled for hip fracture surgery in our institution. In all patients, an anesthesiologist performed a detailed preoperative evaluation and decided the need for the cardiac consultation. Patients underwent preoperative cardiac evaluation by a trained cardiologist using the algorithms proposed in the recent preoperative guidelines. The in-hospital mortality was the main outcome of the study.ResultsIn total, 277 elderly patients undergoing hip fracture surgery were enrolled in this analysis. The overall in-hospital mortality rate was 12.1% (n=30 cases). In a multivariate analysis, we found that insulin dependency, cancer, urea, presence of atrial fibrillation (AF) (OR: 3.906; 95% CI 1.470 to 10.381; p=0.006) and pulmonary artery systolic pressure (PASP) (OR: 1.057; 95% CI 1.016 to 1.100; p=0.006) were the predictors of in-hospital mortality. The receiver operating characteristic curve analysis revealed that the optimal value of PASP in predicting the in-hospital mortality was 35 mm Hg (area under the curve=0.71; 95% CI 0.60 to 0.81, p<0.001) with sensitivity of 87.7% and specificity of 59.5%.ConclusionThe present research found that the preoperative cardiac risk factors, namely AF and PASP, might be associated with increased in-hospital mortality in elderly patients without heart failure undergoing hip fracture surgery.

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Effect of Heart Failure With Preserved Ejection Fraction on Perioperative Outcomes in Patients Undergoing Hip Fracture Surgery

Cited by 13 publications

References 34 publications

Mortality and Medical Complications of Subtrochanteric Fracture Fixation

Mortality and Medical Complications of Subtrochanteric Fracture Fixation

<p>Prediction of Early Postoperative Major Cardiac Events and In-Hospital Mortality in Elderly Hip Fracture Patients: The Role of Different Types of Preoperative Cardiac Abnormalities on Echocardiography Report</p>

Preoperative cardiac risk factors associated with in-hospital mortality in elderly patients without heart failure undergoing hip fracture surgery: a single-centre study

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