1. Cardiac overscreening hip fracture patients
- Author
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G D Slooter, B P W van Wunnik, Martijn Poeze, J P A M Verbruggen, S.J.M. Smeets, RS: NUTRIM - R3 - Respiratory & Age-related Health, MUMC+: MA Heelkunde (9), MUMC+: NAZL en ROAZ (9), and Surgery
- Subjects
medicine.medical_specialty ,SURGICAL DELAY ,Multivariate analysis ,IMPACT ,Trauma Surgery ,acc/aha guideline ,geriatric ,preoperative screening ,elderly-patients ,GUIDELINES ,Perioperative Care ,Hip fracture ,transthoracic echocardiography ,03 medical and health sciences ,0302 clinical medicine ,early surgery ,Internal medicine ,medicine ,Humans ,Mass Screening ,Orthopedics and Sports Medicine ,Prospective Studies ,Prospective cohort study ,time ,AORTIC-STENOSIS ,risk ,030222 orthopedics ,Overscreening ,Hip Fractures ,business.industry ,MORTALITY ,030229 sport sciences ,General Medicine ,Perioperative ,Guideline ,Cardiac screening ,medicine.disease ,Cardiovascular Diseases ,Relative risk ,Orthopedic surgery ,Surgery ,Guideline Adherence ,business - Abstract
Background The aim of this study was to prospectively investigate the adherence to the American College of Cardiology (ACC) and the American Heart Association guidelines for perioperative assessment of patients with hip fracture in daily clinical practice and how this might affect outcome. Methods This prospective cohort study from Maastricht University Medical Centre included 166 hip fracture patients within a 3-year inclusion period. The preoperative cardiac screening and adherence to the ACC/AHA guideline were analyzed. Cardiac risk was classified as low, intermediate and high risk. Secondary outcome measurements were delay to surgery, perioperative complications and in-hospital, 30-day, 1-year and 2-year mortality. Results According to the ACC/AHA guideline, 87% of patients received correct preoperative cardiac screening. The most important reason for incorrect preoperative cardiac screening was overscreening (> 90%). Multivariate analysis showed that a cardiac consultation (p = 0.003) and overscreening (p = 0.02) as significant predictors for increased delay to surgery, while age, sex, previous cardiac history and preoperative mobility were not. High risk patients had in comparison with low risk patients a significantly higher relative risk ratio for in-hospital mortality (RR 6, 95% CI 2–17). Multivariate analysis showed that a previous cardiac history and increased delay to surgery were predictors for early mortality. High age and previous cardiac history were risk factors for late mortality. Conclusion Preoperative cardiac screening for hip fracture patients in adherence to the ACC/AHA guideline is associated with a diminished use of preoperative resources. Overscreening leads to greater delay to surgery, which poses a risk for perioperative complications and early mortality. Level of evidence II.
- Published
- 2019