Clinical Interventions in Aging (May 2020)
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
Abstract
Xuepan Chen,1,2,* Yuanchen Ma,1,* Zhantao Deng,1 Qingtian Li,1 JunXing Liao,1 Qiujian Zheng1 1Department of Orthopedics, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences;School of Medicine, South China University of Technology, Guangzhou, People’s Republic of China; 2Shantou University Medical College, Shantou, People’s Republic of China*These authors contributed equally to this workCorrespondence: Qiujian ZhengDepartment of Orthopedics, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, No. 106, Zhongshan Second Road, Yuexiu District, Guangzhou 510000, People’s Republic of ChinaEmail [email protected]: 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. In addition, age (OR: 1.264, 95% CI: 1.047– 1.527, p=0.015), history of CAD (OR: 19.290, 95% CI: 2.002– 185.885, p=0.010), presence of AS (OR:7.164, 95% CI: 1.988– 51.413, p=0.040) and LVEF < 50% (OR:8.803, 95% CI: 1.115– 69.472, p=0.039) were independent predictors of mortality. However, the rest of preoperative TTE abnormalities were not associated with postoperative cardiac complications or mortality.Conclusion: Among the TTE abnormalities presented by elderly patients with hip fracture, moderate-severe AS was the predictor of postoperative cardiac complications. Moreover, moderate-severe AS and LVEF < 50% were the predictors of in-hospital mortality. Therefore, we could simplify the TTE process by assessing aortic valve and LVEF specifically on focused echocardiography, which could avoid surgery delay.Keywords: aging, hip fracture surgery, mortality, postoperative cardiac complications, echocardiographic abnormality
