Preoperative cardiac abnormalities associated with one-year mortality in elderly patients undergoing hip fracture surgery: role of focused transthoracic echocardiography.

PURPOSE: We sought to identify preoperative cardiac abnormalities with routine preoperative transthoracic echocardiography (TTE) associated with postoperative mortality in elderly patients undergoing hip fractures surgery, in order to provide reference for focused TTE.

METHODS

In this retrospective study, a total of 669 elderly patients (age over 65 years) undergoing hip fractures surgery were included, of which 58 (8.7%) died within one-year after discharge. Cox regression analysis models were used to identify the prognostic cardiac abnormalities of postoperative mortality.

RESULTS

Univariate analysis showed that age (HR 1.065, 95%CI 1.030-1.101; P<0.001), ASA score (III, IV vs. I, II) (HR 1.855, 95%CI 1.098-3.067; P=0.022), history of chronic obstructive pulmonary disease (COPD) (HR 4.446, 95%CI 1.909-10.355; P=0.001) and atrial fibrillation (AF) (HR 3.803, 95%CI 1.803-8.024; P<0.001), presence of left ventricular ejection fraction (LVEF)<50% (HR 5.009, 95%CI 2.151-11.665; P<0.001), left ventricular dilatation (HR 3.813, 95%CI 1.730-8.403; P=0.001), pulmonary arterial systolic pressure (PASP)>25mmHg (HR 4.388, 95%CI 2.492-7.725; P<0.001), moderate-severe aortic valve stenosis (AS) (HR 4.702, 95%CI 1.471-15.035; P=0.009) were the dominant predictors of mortality within one-year. The presence of LVEF<50%, left ventricular dilatation and elevated PASP were proved to be the independent predictors of one-year mortality in elderly patients in multivariate analysis.

CONCLUSION

Cardiac abnormalities derived from preoperative TTE, namely LVEF<50%, AS, left ventricular dilatation and elevated PASP had prognostic value for elderly patients undergoing hip fracture surgery. We consider that these indices would be clinically important regarding the preoperative cardiac risk assessment of elderly hip fracture, which may be assessed in the focused TTE.