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. 2011 Sep 23:6:49.
doi: 10.1186/1749-799X-6-49.

Pre-operative echocardiogram in hip fracture patients with cardiac murmur--an audit

Prithee Jettoo  1 , Rajesh Kakwani, Shahid Junejo, Imtiyaz Talkhani, Paul Dixon
Affiliations

Pre-operative echocardiogram in hip fracture patients with cardiac murmur--an audit

Prithee Jettoo et al. J Orthop Surg Res. .

Abstract

Background: All hip fracture patients with a cardiac murmur have an echocardiogram as a part of their preoperative work-up in our unit. We performed a retrospective audit to assess the impact of obtaining a pre-operative echocardiogram on the management of hip fracture patients.

Methods: All hip fracture patients (N = 349) between 01/06/08 and 01/06/09 were included in the study. 29 patients had pre-operative echocardiogram (echo group). A computer generated randomised sample of 40 patients was generated from N, 'non-echo' group. Data was obtained from medical records and the Hospital Information Support System (HISS). The groups were compared using Student's t test. Approval was obtained locally from the clinical governance department for this project.

Results: Age and gender distribution were similar in both groups. Indication for echo was an acute cardiac abnormality in 4 cases. 25 patients had echo for no new cardiac problem (indication being cardiac murmur in 23 patients and extensive cardiac history in 2 cases). Cardiology opinion was sought in 5 cases. No patient required cardiac surgery or balloon angioplasty preoperatively. Patients having pre-operative echo had significant delay to surgery (average 2.7 days, range 0-6 days) compared to 'non-echo' group (average 1.1 days, range 0-3 days), (p < 0.001). There was no significant difference in length of stay (p = 0.14) and mortality at 30 days (p = 0.41) between the groups.

Conclusion: We have developed departmental guidelines for expediting echo requests in hip fracture patients with cardiac murmur. A liaison has been established with our cardiology department to prioritise such patients on the Echocardiography waiting list, to prevent unnecessary avoidable delay. Careful patient selection for pre-operative echocardiography is important to avoid unnecessary delay to surgery.

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Figures

Figure 1
Figure 1
Pie chart shows the indication for requests of echocardiogram.
Figure 2
Figure 2
The bar-chart shows the results of echocardiography.
Figure 3
Figure 3
Bar chart illustrates significant delay to surgery between the 2 groups.
See this image and copyright information in PMC

References

    1. Department of Health. Hospital Episode Statistics (England) 2006.
    1. Gullberg B, Johnell O, Kanis JA. Worldwide projections for hip fracture. Osteoporosis International. 1997;7:407–13. doi: 10.1007/PL00004148. - DOI - PubMed
    1. The National Confidential Enquiry into Peri-operative Deaths Report 2001. Changing the way we operate. http://www.ncepod.org.uk/2001cwo.htm (accessed 19/10/10)
    1. Eltchaninoff H, Tron C, Cribier A. Percutaneous implantation of aortic valve prosthesis in patients with calcific aortic stenosis: technical aspects. J Interv Cardiol. 2003;16(6):515–21. doi: 10.1046/j.1540-8183.2003.01051.x. - DOI - PubMed
    1. Sandby-Thomas M, Sullivan G, Hall JE. A national survey into the peri-operative anaesthetic management of patients presenting for surgical correction of a fractured neck of femur. Anaesthesia. 2008;63:250–258. doi: 10.1111/j.1365-2044.2007.05328.x. - DOI - PubMed