title: The impact on cardiac diagnosis and mortality of focused transthoracic echocardiography in hip fracture surgery patients with increased risk of cardiac disease: a retrospective cohort study.
abstract: Hip fracture surgery is associated with a high rate of mortality and morbidity; heart disease is the leading cause and is often unrecognised and inadequately treated. Pre-operative focused transthoracic echocardiography by anaesthetists frequently influences management, but mortality outcome studies have not been performed to date. Mortality over the 12 months after hip fracture surgery, in 64 patients at risk of cardiac disease who received pre-operative echocardiography, was compared with 66 randomised historical controls who did not receive echocardiography. Mortality was lower in the group that received echocardiography over the 30 days (4.7% vs 15.2%, log rank p=0.047) and 12 months after surgery (17.1% vs 33.3%, log rank p=0.031). Hazard of death was also reduced with pre-operative echocardiography over 12 months after adjustment for known risk factors (hazard ratio 0.41, 95% CI 0.2-0.85, p=0.016). Pre-operative echocardiography was not associated with a delay in surgery. These data support a randomised controlled trial to confirm these findings.
authors.affiliation: Department of Anaesthesia and Pain Management  Consultant Cardiothoracic Surgeon, Department of Surgery, Royal Melbourne Hospital, Melbourne, Australia. dcanty@unimelb.edu.au
authors.forename: D J
authors.initials: DJ
authors.lastname: Canty
authors.forename: C F
authors.initials: CF
authors.lastname: Royse
authors.forename: D
authors.initials: D
authors.lastname: Kilpatrick
authors.forename: A
authors.initials: A
authors.lastname: Bowyer
authors.forename: A G
authors.initials: AG
authors.lastname: Royse
mesh_terms: D000368:Aged; D015331:Cohort Studies; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006331:Heart Diseases / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D006620:Hip Fractures / Q000401:mortality / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000401:mortality; D016016:Proportional Hazards Models; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome