title: Preoperative cardiac evaluation in proximal femur fractures and its effects on the surgical outcome.
abstract: OBJECTIVE
  The aim of the current study was to evaluate the impact of cardiac risk stratification and preoperative cardiac evaluation on final outcomes in patients with acute proximal femur fractures.
  
  
  METHODS
  This retrospective review included one hundred and three patients who underwent a preoperative cardiac evaluation prior to proximal femur fracture operation between 2004 and 2007 at a tertiary care hospital. Patients were divided into two groups. Group A included 76 patients who were tested with ECG only and Group B included 27 patients with additional clearance. All of these files were reviewed according to a set pro forma. Statistical analysis was done using the SPSS 17 software. The Student's t-test and Mann-Whitney U test were applied to compare two means.
  
  
  RESULTS
  Fifty-three patients had intertrochanteric fractures and 50 had femoral neck fractures. Only 7 patients had a metabolic equivalent task of less than 4. Group B patients had significant delay in time from triage to surgery (p<0.0001) and from surgery to ambulation (p<0.005). Group B patients also had an increased length of hospital stay, although no significant effect on perioperative mortality was observed.
  
  
  CONCLUSIONS
  Preoperative cardiac evaluation is associated with delay in surgery and subsequent ambulation. Delay in surgery is not associated with increased perioperative mortality at our institute. However, the set of guidelines proposed by ACC/AHA should be followed, as the selection of patients for additional investigation was not justifiable in most cases.
authors.affiliation: Section of Orthopedic Surgery, Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan. kashah_pk@yahoo.com
authors.forename: Kashif
authors.initials: K
authors.lastname: Abbas
authors.forename: Masood
authors.initials: M
authors.lastname: Umer
authors.forename: Raza
authors.initials: R
authors.lastname: Askari
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000150:complications / Q000453:epidemiology*; D005260:Female; D005264:Femoral Fractures / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009017:Morbidity / Q000639:trends; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology