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

• Published in: Postgraduate medical journal Vol. 97; no. 1153; pp. 701 - 705
• Main Authors: Çiçek, Vedat, Cinar, Tufan, Hayiroglu, Mert Ilker, Kılıç, Şahhan, Keser, Nürgül, Uzun, Mehmet, Orhan, Ahmet Lütfullah
• Format: Journal Article
• Language: English
• Published: England The Fellowship of Postgraduate Medicine 01-11-2021; Oxford University Press
• Subjects: Aged; Aged, 80 and over; Anticoagulants; Blood; Cardiac arrhythmia; Cardiology; Cardiovascular disease; Chronic obstructive pulmonary disease; Echocardiography; Ejection fraction; Female; Fractures; health services administration & management; Heart failure; Heart Function Tests - methods; Hemoglobin; hip; Hip Fractures - complications; Hip Fractures - surgery; Hospital Mortality; Hospitals; Humans; internal medicine; Male; Mortality; Older people; Original research; Orthopaedic & trauma surgery; Preoperative Care - methods; Pulmonary arteries; Retrospective Studies; Risk assessment; Risk Factors; risk management; Risk Management - methods; Statistical analysis; Surgery; Ultrasonic imaging; Variables; United States > US; internal medicine; risk management; Orthopaedic & trauma surgery; cardiology; hip; health services administration & management
• ISSN: 0032-5473; 1469-0756
• DOI: 10.1136/postgradmedj-2020-138679

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.