Effect of Preoperative Transthoracic Echocardiogram on Mortality and Surgical Timing in Elderly Adults with Hip Fracture

OBJECTIVES: To evaluate the effect of preoperative transthoracic echocardiogram (TTE) on mortality, postoperative complications, surgical timing, and length of stay in individuals with surgically treated hip fracture. DESIGN: Retrospective chart review of hospital records. SETTING: Level I and II trauma centers. PARTICIPANTS: Individuals consecutively surgically treated for hip fracture (N = 694). MEASUREMENTS: Demographic and injury characteristic, operative timing, preoperative echocardiogram, complications, mortality. Primary outcome measure was in hospital, 30-day, and 1-year mortality. Secondary outcome measures were complications (particularly cardiovascular) and time required for medical clearance and operative treatment. RESULTS: Preoperative TTE was performed on 131 individuals (18.9%). There was no difference between the TTE group and the control group in hospital (3.8% vs 1.8%, P = .18), 30-day (6.9% vs 6.6%, P = .90), or 1-year (20.6% versus 20.1%, P = .89) mortality. There was no significant difference in major cardiac complications. Average time from admission to operative treatment was 66.5 hours in the TTE group and 34.8 hours in the control group (P < .001). Average time from admission to medical clearance was 43.2 hours in the TTE group and 12.4 hours in the control group (P < .001). The TTE group also had a significantly longer length of stay (8.68 vs 6.44 days, P < .001). CONCLUSION: Preoperative TTE was not associated with lower mortality in elderly adults with hip fracture in the short- or long-term postoperative period. TTE was associated with delayed surgical treatment and longer length of stay and resulted in no cardiac intervention (e.g., cardiac catheterization, stent, stress test).