OTA 2012 Posters

Scientific Poster #16 Hip/Femur OTA-2012

What is the Clinical and Economic Impact of Preoperative Transthoracic Echocardiography on Elderly Patients With Hip Fractures?

Andrew J. Marcantonio, MD; Brandon M. Steen, MD; Michael S. Kain, MD;
Kasey J. Bramlett, PA-C; John F. Tilzey, MD; Richard Iorio, MD;
Lahey Clinic Medical Center, Burlington, Massachusetts, USA

Purpose: Elderly patients with hip fractures frequently require preoperative medical consultation. The purpose of this study was to evaluate the effect of preoperative transthoracic echocardiography (TTE) on perioperative cardiac intervention, choice of regional or general anesthesia, timing of hip surgery, length of stay, inpatient mortality, and economic impact.

Methods: A retrospective case-controlled series of patients >65 years old who had hip fracture surgery was analyzed. 43 patients who had preoperative TTE were identified. 161 consecutive hip fracture patients who did not undergo TTE were used as a control group for comparison. Data collected included American Society of Anesthesiologists (ASA) score, comorbidities, indication for TTE, time from admission to surgery, need for perioperative cardiac intervention, choice of anesthesia, length of stay, and inpatient mortality. A resource-based hospital accounting system (TSI Inc) provided actual hospital cost data for each procedure.

Results: In the TTE group 1 of 43 patients (2.4%) had a cardiac intervention (percutaneous transluminal coronary angioplasty and coronary artery bypass grafting). There were no cardiac interventions in the control group. Average time to operating room was 1.5 days in the TTE group and 0.93 days in the control group (P <0.001). Average length of stay was 7.2 days in the TTE group and 6.0 days in the control group (P = 0.04). In patients with a preoperative ASA score of 3 or 4, length of stay in the TTE group was 7.3 days, and 6.3 days in the control group (P = 0.18). Inpatient mortality was 2.3% in the TTE group and 3% in the control group (P = 0.493). There was no correlation between findings on TTE and choice of anesthesia. A comparison of hospital costs for patients who underwent TTE and the control group demonstrated a significant difference in hospital cost between the groups (TTE $24,445 vs control $18,429, P = 0.02).

Conclusions/Significance: Preoperative TTE in elderly patients with hip fractures resulted in a low cardiac intervention rate. Patients who underwent preoperative TTE prior to hip fracture repair had significantly longer times to operation, longer lengths of stay, and significantly higher hospital costs. The utility of TTE as a preoperative screening tool is limited in the geriatric hip fracture population and does not appear to affect perioperative mortality rates.

• The FDA has not cleared this drug and/or medical device for the use described in this presentation   (i.e., the drug or medical device is being discussed for an “off label” use).  ◆FDA information not available at time of printing. Δ OTA Grant.