Archives of the Balkan Medical Union (Dec 2018)
The influence of preoperative cardiovascular assessment and time to surgery on postoperative mortality after surgery for femoral neck fractures in elderly patients
Abstract
Introduction. A better predictive tool to use for assessing the risk of cardiovascular complications and postoperative mortality in elderly with femoral neck fracture is still not fully developed, and new data in stratifying the cardiovascular risk are still necessary. The objective of the study was to determine the influence of preoperative variables from the cardiovascular preoperative assessment on mortality, and to try to set some standards in the preoperative management of patients with cardiac risk and hip fractures who need surgery. Material and methods. We analyzed age, metabolic equivalents according (METS) to Duke Activity Status Index (DASI), hemoglobin, N-terminal prohormone of brain natriuretic peptide (NT-proBNP) and high sensitive C-reactive protein values, echographic measurements such as left ventricular ejection fraction (LVEF), left ventricular diastolic volume (LVDV) and diameter (LVDD), left ventricular wall hipertrophy (LVH) calculated as a mean of the posterior wall and the interventricular septum, the left ventricular contraction velocity S, pulmonary artery pressure (PAPs), the tricuspid anular plane systolic excursion (TAPSE), and time to surgery, for 72 patients aged over 60 y.o, hospitalised in the Orthopaedics Department of the University Emergency Hospital of Bucharest, Romania, between 2015-2016. Results. The deaths after 3 months from surgery were 13 (18%). The best correlation with 3 month mortality was the delay in surgery over 4 days (p<0,0001), with an area under the ROC curve of 0.943 and NT-proBNP values over 731 pg/L (p<0.0001) and an area under the ROC curve of 0.898. Good correlations were found for an echocardiographic value of s < 7.7, with an area under the curve of 0.745 and a TAPSE < 19.5, corresponding to a area under the curve of 0.807. Conclusions. The mortality was relatively high, and in our opinion, the gold standard should be speeding up the cardiovascular investigations and compensation of cardiovascular pathology, to allow surgery as early as possible, for a better survival of patients with femoral neck fractures.
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