Clinical guidelines reduce unnecessary preoperative echocardiograph in elderly hip fracture patients

Background The American College of Cardiology (ACC) and the American Heart Association (AHA) have set up guidelines for preoperative usage of transthoracic echocardiograph (TTE) in case of non-cardiac surgery. Unnecessary TTE would increase hospital cost and delay surgery. Therefore, we aimed to analyze whether the TTE before hip fracture surgery was in accordance with guidelines and what the effects were on outcome. Methods 281 elderly patients who had surgery for an isolated hip fracture were involved. The preoperative TTE test and adherence to the guideline were analyzed. TTE reports were reviewed for the presence of major cardiac abnormality with potentiality to change perioperative management, including left ventricular systolic or diastolic dysfunction, pericardial effusion, moderate or severe valvular disease, and pulmonary hypertension. Primary outcome was time to surgery (TTS), length of hospital stay (LLS), postoperative complications. Secondary outcome was sensitivity and specificity of accordance with the guideline for identifying which patients would have TTE that demonstrated major cardiac abnormality. Results Of the 281 patients included, 174 patients (61.9%) received the TTE, whereas 107 patients did not. Only 71 of the 174 patients (40.8%) with TTE met the guidelines. Among the 202 patients who did not meet the guidelines (103 with TTE and 99 without TTE), those who received a preoperative TTE had a longer TTS (4.24 vs. 2.10 days, P = 0.000) and LOS (10.44 vs. 7.72 days, P=0.000). There were no differences in postoperative complication, the sensitivity and specificity of guidelines as the screening tool to identify patients with major cardiac abnormality was 86.7% and 68.7%. Conclusion Preoperative TTE is frequently overused out of guidelines and lead to unnecessary surgery delay while not reducing the rate of postoperative complications. Stricter adherence to guidelines should be recommended, as it would help decrease unnecessary test.