The effect of aortic stenosis on elderly hip fracture outcomes: A case control study

Keswani, Aakash; Lovy, Andrew J.; Khalid, Mian; Blaufarb, Ira; Moucha, Calin S.; Forsh, David A.; Chen, Darwin

doi:10.1016/j.injury.2015.10.015

Cited by 27 publications

(39 citation statements)

References 29 publications

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“…The incidence of severe AS in patients who need surgery for hip fracture is between 5% and 10% 6. Although after hip surgery 30-day mortality in severe AS is between 7% and 14%,7–9 these data may be an underestimate since the diagnosis of AS is not uncommonly missed before surgery. In fact only few centers have an echocardiography service that may allow assessment of AS severity without delaying surgery.…”

Section: Introductionmentioning

confidence: 99%

Outcome in elderly patients with aortic stenosis undergoing hip fracture surgery. Results may suggest a different postoperative strategy?

Rostagno

Ranalli

Polidori

et al. 2019

Trauma Surg Acute Care Open

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BackgroundFive to ten percent of patients with hip fracture have severe aortic valve stenosis (AS). The aim of the present investigation was to evaluate the impact of AS on early and long-term outcome after surgery for hip fracture.Methods145 patients with AS and 283 consecutive patients without AS (control group) aged >70 years referred to Azienda Ospadaliera Universitaria (AOU) Careggi for hip fracture were included in the study. The endpoints were incidence of postoperative myocardial infarction, 30-day and 1-year mortality, and a composite endpoint (30-day mortality + myocardial infarction).Results66 patients had mild, 47 moderate and 32 severe AS according to the European Society of Cardiology guidelines. 30-day mortality was 6.2% in AS and 3.1% in controls. Postoperative non-fatal myocardial infarction and composite endpoint were more frequent in AS than in the control group (8.3% vs 1.1%, p<0.001 and 14.5% vs 4.2%, p<0.001, respectively). The risk was significantly higher for patients with severe AS (28.1%). 1-year mortality in patients with moderate/severe AS was 46% in comparison with 16% in mild AS or in the control group (p<0.001). Coronary disease, atrial fibrillation, age, and aortic gradient were independent predictors of mortality in AS.DiscussionAS significantly affects postoperative outcome after surgery for hip fracture. Since not infrequently AS is incidentally diagnosed during hospitalization after trauma, which should be the management in these patients after hip surgery? How many might benefit from surgical valve replacement or transcatheter aortic valve replacement? A heart team evaluation may be suggested before discharge for most of these patients.Level of evidenceIV.

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Section: Introductionmentioning

confidence: 99%

Outcome in elderly patients with aortic stenosis undergoing hip fracture surgery. Results may suggest a different postoperative strategy?

Rostagno

Ranalli

Polidori

et al. 2019

Trauma Surg Acute Care Open

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“…Heart failure has been identified in several studies as being associated with a poorer outcome when noncardiac surgery is performed [5][6][7] . Valvular heart disease, especially severe aortic and mitral stenosis, poses the greatest risk for noncardiac surgery [24,25] . We did not find a relationship between heart failure, valvular disease, and cardiac complications in our study.…”

Section: Resultsmentioning

confidence: 99%

Preoperative evaluation of patients with cardiovascular disease for noncardiac surgery

Can¹,

Kocyigit²,

Hayirlioğlu³

et al. 2018

GKDA Derg

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Objective: Preoperative evaluation of the patients with cardiac problems who will undergo noncardiac surgery is crucial. The aim of our study is to investigate the relationship between cardiac risk determined by the American Society of Anesthesiologists (ASA) classification, Goldman scoring system, and the cardiology consultation, and the perioperative mortality and morbidity. Material and Method:Five hundred patients undergoing noncardiac surgery for whom cardiology consultation requested were studied prospectively. The relationship between the patients' ASA classes, Goldman scores, cardiac risks, comorbidities, operation types, preoperative cardiac symptoms, and perioperative morbidity and mortality was assessed. Results:The mean age in the group with morbidity (69.3±10.6 years) was significantly higher than that in the group without morbidity (64.0±12.1 years) (p<0.001). There was no perioperative mortality while in 354 (70.8%) of 500 patients cardiovascular complications developed.While a significant difference between operation type of both groups was observed (p=0.001), preoperative hypertension was more frequently seen in the morbidity group (p=0.007). Preoperative ASA classes (p=0.016), Goldman scores (p<0.001), and cardiac risks of patients (p=0.039) were significantly different between the groups. Logistic regression analysis was applied, and only age, hypertension, and operation type were found to be risk factors for perioperative morbidity. Conclusion:We believe that ASA classification, Goldman Cardiac Risk Index, and cardiac risk determined by the cardiologists can affect the patients' perioperative management . Besides use of risk indices and algorithms can reduce the requirement for consultation and request for unnecessary laboratory or imaging tests and can prevent unnecessary cancellation or delaying of the surgery. ÖZ Nonkardiyak Cerrahi Geçirecek Kardiyovasküler Hastalığı Olan Hastaların Preoperatif DeğerlendirilmesiAmaç: Nonkardiyak cerrahi geçirecek kardiyak sorunlu hastaların preoperatif değerlendirmesi oldukça kritiktir. Çalışmamızın amacı, Amerikan Anestezistler Derneği (ASA) sınıflaması, Goldman skorlama sistemi ve kardiyoloji konsültasyonu ile belirlenen kardiyak risk ile perioperative mortalite ve morbidite arasındaki ilişkinin araştırılmasıdır. Gereç ve Yöntem:Nonkardiyak cerrahi geçirecek, kardiyoloji konsültasyonu istenen 500 hasta prospektif olarak çalışmaya alındı. Hastaların ASA sınıfları, Goldman skorları, kardiyak riskleri, komorbiditeleri, operasyon tipleri, preoperative kardiyak semptomları ile perioperative mortalite ve morbidite arasındaki ilişki değerlendirildi.Bulgular: Morbidite gelişen grupta ortalama yaş (69.3±10.6) morbidite gelişmeyen gruba göre (64.0±12.1) anlamlı olarak yüksekti (p<0.001). Çalışmamızda perioperative mortalite gözlenmezken, 500 hastanın 354 (%70,8) ünde kardiyovasküler komplikasyon gelişti. Ameliyat tipi açısından iki grup arasında anlamlı farklılık gözlenirken (p=0.001), preoperatif hipertansiyon varlığı morbidite gelişen grupta daha sıktı (p=0.00...

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“…However, unlike the results of that study, the outcomes were worse for the patients included this study. These results reported by Keswani et al urged the clinicians to be more vigilant in their management of moderate to severe asymptomatic AS in patients undergoing hip fracture surgery [13].…”

Section: Reviewmentioning

confidence: 92%

“…In an attempt to analyze this issue in elderly, Leibowitz ), and ORIF 21 (32%) vs. 40 (31%). Of note, patients who underwent an aortic replacement procedure within last 12 months before and after the study were excluded [13]. Hence, these patients, similar to those studied by Leibowitz et al, had untreated moderate to severe asymptomatic AS [12].…”

Section: Reviewmentioning

confidence: 99%

The Management Dilemma: Concomitant Acute Hip Fracture and Severe Asymptomatic Aortic Stenosis

Ahmed¹,

Safdar²

2020

Cureus

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Acute hip fractures (AHF) are common in elderly patients. A combination of age-related osteoporosis and increased fall risk makes this population group most susceptible to different fractures including acute fracture of the hip. AHF is a disabling condition that warrants immediate attention. It has a huge impact on the already compromised baseline functional status of elderly patients rendering them more susceptible to different morbidities and even mortality. Similarly, age-related degeneration of the aortic valve with resulting calcification also makes elderly patients prone to aortic stenosis (AS). Severe asymptomatic AS when diagnosed in these patients with AHF in the perioperative period makes the management options very challenging. Severity of AS usually translates into worse postoperative outcomes. The management rationale of concomitant presence of these two conditions is unclear. There is a lack of clear-cut recommendations and societal guidelines in such scenario.

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The effect of aortic stenosis on elderly hip fracture outcomes: A case control study

Cited by 27 publications

References 29 publications

Outcome in elderly patients with aortic stenosis undergoing hip fracture surgery. Results may suggest a different postoperative strategy?

Outcome in elderly patients with aortic stenosis undergoing hip fracture surgery. Results may suggest a different postoperative strategy?

Preoperative evaluation of patients with cardiovascular disease for noncardiac surgery

The Management Dilemma: Concomitant Acute Hip Fracture and Severe Asymptomatic Aortic Stenosis

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