The Role of Preoperative Cardiac Investigation in Emergency Hip Surgery

Background: Given the well recognized imperative to treat hip fractures as expeditiously as possible there can arise uncertainty regarding the balance between pre-operative medical optimization and delay of surgery. Echocardiography is often felt to considerably delay surgery with limited change to patient management. Methods: We retrospectively reviewed forty-nine consecutive patients who had echocardiography prior to surgery for hip fracture and compared them to fifty-eight patients who did not have echocardiography. Results: We found that those who had echocardiography were more likely to have medication changes (51.02% vs. 6.9%) but were unlikely to require angiography, bypass or valvular surgery prior to fracture fixation. Those undergoing echo had a longer time to surgery-3.30 days (SD = 2.49) while those in the control group waited 1.5 days (SD = 1.29), (p = 0.005). Rates of spinal anaesthesia were similar in both groups. Conclusions: We feel that these results confirm the theory that echocardiography, as currently provided, significantly delays surgery for hip fracture and that this may negatively affect patient outcomes.