Preoperative Noninvasive Cardiac Testing in Older Adults with Hip Fracture: A Multi-Site Study.

Autor: Sinvani L; Division of Hospital Medicine, Northwell Health System, Manhasset, New York, USA.; Department of Medicine, Northwell Health System, Manhasset, New York, USA.; Center for Health Innovations Research, Feinstein Institutes for Medical Research, Manhasset, New York, USA., Mendelson DA; Department of Medicine, Division of Geriatrics and Aging, University of Rochester, Rochester, New York, USA., Sharma A; Division of Hospital Medicine, Northwell Health System, Manhasset, New York, USA.; Department of Medicine, Northwell Health System, Manhasset, New York, USA., Nouryan CN; Division of Hospital Medicine, Northwell Health System, Manhasset, New York, USA.; Department of Medicine, Northwell Health System, Manhasset, New York, USA.; Center for Health Innovations Research, Feinstein Institutes for Medical Research, Manhasset, New York, USA.; Zucker School of Medicine at Hofstra/Northwell, Hempstead,, New York, USA., Fishbein JS; Biostatistics Division, Feinstein Institute for Medical Research, Manhasset, New York, USA., Qiu MG; Department of Medicine, Northwell Health System, Manhasset, New York, USA., Zeltser R; Department of Medicine, Northwell Health System, Manhasset, New York, USA.; Department of Cardiology, Nassau University Medical Center, East Meadow, New York, USA., Makaryus AN; Department of Medicine, Northwell Health System, Manhasset, New York, USA.; Department of Cardiology, Nassau University Medical Center, East Meadow, New York, USA., Wolf-Klein GP; Department of Medicine, Northwell Health System, Manhasset, New York, USA.; Zucker School of Medicine at Hofstra/Northwell, Hempstead,, New York, USA.
Jazyk: angličtina
Zdroj: Journal of the American Geriatrics Society [J Am Geriatr Soc] 2020 Aug; Vol. 68 (8), pp. 1690-1697. Date of Electronic Publication: 2020 Jun 11.
DOI: 10.1111/jgs.16555
Abstrakt: Background/objectives: For older adults with acute hip fracture, use of preoperative noninvasive cardiac testing may lead to delays in surgery, thereby contributing to worse outcomes. Our study objective was to evaluate the preoperative use of pharmacologic stress testing and transthoracic echocardiogram (TTE) in older adults hospitalized with hip fracture.
Design: Retrospective chart review.
Setting: Seven hospitals (three tertiary, four community) within a large health system.
Participants: Patients, aged 65 years and older, hospitalized with hip fracture (n = 1,079; mean age = 84.2 years; 75% female; 82% white; 36% married).
Measurements: Data were extracted from electronic medical records. The study evaluated associations between patient factors as well as clinical outcomes (time to surgery [TTS], length of stay [LOS], and in-hospital mortality) and the use of preoperative noninvasive cardiac testing (pharmacologic stress tests or TTE). Descriptive statistics were calculated. Cox regression was performed for both TTS and LOS (evaluated as time-dependent variable); logistic regression was used for in-hospital mortality.
Results: Although 34.3% (n = 370) had a preoperative TTE, .7% (n = 8) underwent a nuclear stress test and none had a dobutamine stress echocardiogram. Median TTS was 1.1 days (IQR [interquartile range] = .8-1.8 days), median LOS was 5.3 days (IQR = 4.2-7.2 days), and in-hospital mortality was 3% (n = 32). Patients admitted to the medical service had 3.5 times greater odds of undergoing a TTE compared with those on the orthopedic service (P < .001). Community hospitals had almost three times greater odds of preoperative TTE than tertiary centers (P < .001). In multivariable analysis, preoperative TTE was significantly associated with increased TTS (P < .001). No difference in mortality was found between patients with and without a preoperative TTE.
Conclusion: This study highlights the high rate of TTE in preoperative assessment of older adults with acute hip fracture. Given the association between TTE and longer TTS, further studies must clarify the role of preoperative TTE in this population. J Am Geriatr Soc 68:1690-1697, 2020.
(© 2020 The American Geriatrics Society.)
Databáze: MEDLINE
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