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Preoperative Noninvasive Cardiac Testing in Older Adults with Hip Fracture: A Multi‐Site Study
Author(s) -
Sinvani Liron,
Mendelson Daniel A.,
Sharma Ankita,
Nouryan Christian N.,
Fishbein Joanna S.,
Qiu Michael G.,
Zeltser Roman,
Makaryus Amgad N.,
WolfKlein Gisele P.
Publication year - 2020
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.16555
Subject(s) - medicine , interquartile range , logistic regression , hip fracture , medical record , odds ratio , odds , retrospective cohort study , stress testing (software) , emergency medicine , orthopedic surgery , surgery , osteoporosis , computer science , programming language
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.