Key result
Preoperative echocardiography in hip fracture patients is linked to ~217% higher in-hospital mortality.
Why the study?
Guidelines suggest echocardiography to improve risk stratification before hip fracture surgery, but it is frequently omitted over concerns of delaying surgery.
Does preoperative echocardiography delay surgery or predict in-hospital mortality in elderly patients with hip fractures?
Observational (n=2,272)
No
Does preoperative echocardiography delay surgery or predict in-hospital mortality in elderly patients with hip fractures?
Absolute Event Rate: 7.3% vs 2.3%
Preoperative echocardiography in elderly hip fracture patients identifies a high-risk population for in-hospital mortality, specifically those with reduced LVEF and pulmonary hypertension.
Supports targeted echocardiography for risk stratification in elderly hip fracture patients; leaves open whether routine use improves outcomes or merely reflects selection bias.
Background: Cardiovascular complications are the main cause of early mortality in elderly patients after hip fracture surgery. Echocardiography, although suggested by guidelines to improve risk stratification, is frequently omitted due to the risk of delaying surgery. The aim of the study was to evaluate whether in a multidisciplinary hip fracture unit, echocardiography can be performed without a delay in surgery. The secondary endpoint was to research the possible association between echocardiographic abnormalities and in-hospital mortality. Methods: The study included hip fracture patients aged > 70 admitted in the period 1 January 2019 to 31 December 2024, to the hip fracture unit of a tertiary teaching hospital. Echocardiography was indicated according to clinical criteria (detection of heart murmur, pathological electrocardiographic changes, known heart disease and the presence of ≥3 coronary risk factors). In the study, there were 2272 patients; 1593 had indications for preoperative echocardiography, which was performed in 1502. Mean age was significantly higher in the ECHO group than in the NO ECHO group (85.4 ± 8 vs. 80.5 ± 11 years, p < 0.0001). ECHO group patients more frequently had at least two comorbidities and more severe functional impairment. In-hospital mortality was 7.3% in ECHO patients compared to 2.3% in NO ECHO patients. Results: Multivariate analysis showed that decreased left ventricular ejection fraction and pulmonary hypertension, as well as age, anemia, and reduced functional capacity expressed as lost BADL, were associated with in-hospital mortality. Conclusions: Echocardiography identifies a population at a high risk of in-hospital mortality, three times higher compared to the group of NO ECHO patients. In those who underwent echocardiography, a reduced left ventricular ejection fraction and an increase in pulmonary pressure were associated with in-hospital mortality.
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Rostagno et al. (2026) conducted an observational in Hip fracture (n=2,272). Preoperative echocardiography vs. No preoperative echocardiography was evaluated on In-hospital mortality. Preoperative echocardiography identified hip fracture patients at higher risk, with an in-hospital mortality of 7.3% compared to 2.3% in those who did not undergo echocardiography.
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