Routine preoperative echocardiography before operative repair of hip fracture does not reduce mortality or postoperative complcayions.

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• Hiroshi Yonekura, Kazuki Ide, Yoshika Onishi, Isao Nahara, Chikashi Takeda, and Koji Kawakami.
• From the Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan.
• Anesth. Analg. 2019 Feb 1; 128 (2): 213-220.

BackgroundThe effect of preoperative transthoracic echocardiography on the clinical outcomes of patients with hip fractures undergoing surgical treatment remains controversial. We hypothesized that preoperative echocardiography is associated with reduced postoperative morbidity and improved patient survival after surgical repair of hip fractures.MethodsDrawing from a nationwide administrative database, patients undergoing hip fracture surgeries between April 1, 2008 and December 31, 2016 were included. We examined the association of preoperative echocardiography with the incidence of in-hospital mortality using propensity score matching. Secondary outcomes included postoperative complications, the incidence of postoperative intensive care unit admissions, and length of hospital stay. For sensitivity analyses, we restricted the overall cohort to include only hip fracture surgeries performed within 2 days from admission.ResultsOverall, 34,679 (52.1%) of 66,620 surgical patients underwent preoperative echocardiography screening. The screened patients (mean [SD] age, 84.3 years [7.7 years]; 79.0% female) were propensity score matched to 31,941 nonscreened patients (mean [SD] age, 82.1 years [8.7 years]; 78.2% female). The overall in-hospital mortality, before propensity matching, was 1.8% (1227 patients). Propensity score matching created a matched cohort of 25,205 pairs of patients. There were no in-hospital mortality differences between the 2 groups (screened versus nonscreened: 417 [1.65%] vs 439 [1.74%]; odds ratio, 0.95; 95% confidence interval, 0.83-1.09; P = .45). Preoperative echocardiography was not associated with reduced postoperative complications and intensive care unit admissions. In sensitivity analysis, we identified 25,637 patients from the overall cohort (38.5%) with hip fracture surgeries performed within 2 days of admission. There were no in-hospital mortality differences between the 2 groups (screened versus nonscreened: 1.67% vs 1.80%; odds ratio, 0.93; 95% confidence interval, 0.72-1.18; P = .53). Findings were also consistent with other sensitivity analyses and subgroup analyses.ConclusionsThis large, retrospective, nationwide cohort study demonstrated that preoperative echocardiography was not associated with reduced in-hospital mortality or postoperative complications.

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