Unnecessary Preoperative Cardiology Evaluation and Transthoracic Echocardiogram Delays Time to Surgery for Geriatric Hip Fractures

Objective: Delays to surgery for patients with geriatric hip fracture are associated with increased morbidity and mortality. The American Heart Association (AHA) and American College of Cardiology (ACC) Clinical Practice Guidelines (CPG) were created to standardize preoperative cardiology consultation and transthoracic echocardiogram (TTE). This study's purpose is to determine if these practices are over used and delay time to surgery at a safety net hospital. Design: Retrospective review. Setting: Level 1 trauma center and safety net hospital. Patients: Charts were reviewed for indications of preoperative cardiology consultation or TTE per AHA and ACC CPG in 412 patients admitted with geriatric hip fracture. Intervention: Criteria meeting the AHA/ACC guidelines for preoperative TTE and cardiac consultations. Main Outcome Measurements: Time to surgical intervention. Results: Despite 17.7% of patients meeting criteria, 44.4% of patients received cardiology consultation. Of those patients, 33.8% met criteria for receiving preoperative TTE but 89.4% received one. Time to surgery was greater for patients receiving cardiology consultation (25.42 +/- 14.54 hours, P-value <0.001) versus those who did not (19.27 +/- 13.76, P-value <0.001) and for those receiving preoperative TTE (26.00 +/- 15.33 hours, P-value <0.001) versus those who did not (18.94 +/- 12.92, P-value <0.001). Conclusions: Cardiology consultation and TTE are frequently used against AHA/ACC CPG. These measures are expensive and delay surgery, which can increase morbidity and mortality. These findings persisted despite limited resources available in a safety net hospital. Hospitals should improve adherence to CPG, or modify protocols.

Automated summary

The study found overuse of preoperative cardiology consultation and TTE in geriatric hip fracture patients, leading to delayed surgery and potentially increased morbidity and mortality. Despite limited resources, hospitals should strive to improve adherence to CPG or modify protocols accordingly.