title: The Clinical and Economic Impact of Preoperative Transthoracic Echocardiography in Elderly Patients with Hip Fractures.
abstract: OBJECTIVE
  The purpose of this study was to evaluate preoperative transthoracic echocardiography (TTE) on cardiac intervention, length of stay (LOS), inpatient mortality, and costs.
  
  
  METHODS
  A retrospective series of 43 preoperative TTE and 161 non-TTE (control) hip fracture patients (> 65 years) was reviewed. The data collected included ASA score, comorbidities, indication for TTE, perioperative cardiac intervention, LOS, inpatient mortality, and cost.
  
  
  RESULTS
  One of 43 (2.4%) (TTE) had a cardiac intervention (PTCA/CABG). Zero interventions occurred in the control group. The average time to operation was 1.5 days (TTE) and 0.93 days (control) (p < 0.001). The average LOS was 7.2 days (TTE) and 6.0 days (control), (p = 0.04). Patients (American Society of Anesthesiologists Physical Status Classification 3 and 4 patients), LOS was 7.3 days (TTE) and 6.3 days (control) (p = 0.18). Inpatient mortality was 2.3% (TTE) and 3% (control) (p = 0.493). There was no correlation between TTE and anesthesia. Hospital costs were different between groups (TTE $24,445 and control $18,429, p = 0.02).
  
  
  CONCLUSIONS
  Preoperative TTE in elderly patients with hip fractures resulted in a low cardiac intervention rate. Patients undergoing preoperative TTE prior to surgery had longer times to operation, LOS, and 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 effect perioperative mortality rates.
authors.forename: Andrew
authors.initials: A
authors.lastname: Marcantonio
authors.forename: Brandon
authors.initials: B
authors.lastname: Steen
authors.forename: Michael
authors.initials: M
authors.lastname: Kain
authors.forename: Kasey-Jean
authors.initials: KJ
authors.lastname: Bramlett
authors.forename: John F
authors.initials: JF
authors.lastname: Tilzey
authors.forename: Richard
authors.initials: R
authors.lastname: Iorio
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003362:Cost-Benefit Analysis; D004452:Echocardiography / Q000191:economics*; D005260:Female; D017048:Health Care Costs; D006331:Heart Diseases / Q000150:complications / Q000000981:diagnostic imaging* / Q000191:economics* / Q000401:mortality / Q000628:therapy; D006620:Hip Fractures / Q000150:complications / Q000175:diagnosis / Q000191:economics* / Q000401:mortality / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000191:economics; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D061665:Time-to-Treatment / Q000191:economics; D016896:Treatment Outcome