Perioperative Focused Transthoracic Echocardiogram Evaluations for Elderly Hip Fractures: A Narrative Review of Literature and Recommendations

Multiple comorbidities and limited information at first contact with elderly hip-fracture patients have made it difficult to create safe perioperative plans. Various risk-stratification calculators, laboratory tests and imaging modalities are used to aid anesthesiologists in identifying which patients may need further evaluation and testing before surgery. Delaying surgical intervention in this population for >24 to 48 hours significantly increase perioperative complications such as myocardial infarction, deep venous thrombosis, pulmonary embolism, or pneumonia. Transthoracic echocardiograms (TTEs) are commonly used to identify pertinent cardiac pathologies that could alter anesthetic management. However, their use can often delay care, and its clinical utility has remained a subject of debate. Point-of-care ultrasound (POCUS) has been recognized as an effective tool to efficiently screen patients who might have underlying cardiac pathologies. Thus, anesthesiologists should utilize POCUS skill sets to guide their clinical decision-making and perioperative planning.