title: The medical and economic impact of preoperative cardiac testing in elderly patients with hip fractures.
abstract: OBJECTIVE
  To assess the medical and economic impact of preoperative cardiac testing (stress thallium imaging or echocardiography) on the treatment of elderly patients with hip fractures.
  
  
  METHODS
  235 consecutive patients over the age of 60 treated for a hip fracture (236 fractures) (OTA 31) at a single Level I trauma centre were identified from a prospective orthopaedic trauma database and studied as part of a retrospective cohort series. 35 (15%) had cardiac testing prior to treatment of their hip fracture. The indication for testing was a newly diagnosed cardiac abnormality in 16 of these cases and a prior history of cardiovascular disease without an acute cardiac problem in 19.
  
  
  RESULTS
  Cardiac evaluation did not change the orthopaedic management in any case. No patient underwent cardiac surgery or coronary angioplasty as a result of the testing. In 48% of cases, cardiac testing did not lead to new medical treatment. In 52%, recommendations were only made for medical management of previously known cardiac disease. Patients who had cardiac testing had a significantly greater average delay to surgery (3.3 days) than those who did not (1.9 days), (P<.001). The cost of preoperative cardiac testing totalled more than $44,000 for the 35 patients.
  
  
  CONCLUSIONS
  Preoperative cardiac testing did not lead to changes in perioperative orthopaedic or medical management of elderly patients with hip fractures. Patients undergoing testing had a significant delay to surgery. Extrapolated to the population of elderly hip fracture patients in the United States (250,000 annually), preoperative cardiac testing (performed in 15% of cases) would cost nearly $47,000,000 annually. Preoperative cardiac testing may add profoundly to the healthcare costs associated with treating this population of patients without influencing orthopaedic or medical management.
authors.affiliation: Department of Orthopedic Surgery, Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri, USA. ricciw@wudosis.wustl.edu
authors.forename: William M
authors.initials: WM
authors.lastname: Ricci
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Della Rocca
authors.forename: Christopher
authors.initials: C
authors.lastname: Combs
authors.forename: Joseph
authors.initials: J
authors.lastname: Borrelli
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000191:economics; D015331:Cohort Studies; D003935:Diagnostic Techniques, Cardiovascular / Q000191:economics*; D005260:Female; D006620:Hip Fractures / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000191:economics*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States