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Preoperative Echocardiography for Patients With Hip Fractures Undergoing Surgery

A Retrospective Cohort Study Using a Nationwide Database

Yonekura, Hiroshi, MD, MPH*,†; Ide, Kazuki, PhD*; Onishi, Yoshika, MD*; Nahara, Isao, MD, MPH*; Takeda, Chikashi, MD*,‡; Kawakami, Koji, MD, PhD*

doi: 10.1213/ANE.0000000000003888
Cardiovascular and Thoracic Anesthesiology: Original Clinical Research Report

BACKGROUND: The 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.

METHODS: Drawing 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.

RESULTS: Overall, 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.

CONCLUSIONS: This large, retrospective, nationwide cohort study demonstrated that preoperative echocardiography was not associated with reduced in-hospital mortality or postoperative complications.

From the *Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan

Department of Clinical Anesthesiology, Mie University Hospital, Mie, Japan

Department of Anesthesia, Kyoto University Hospital, Kyoto, Japan.

Published ahead of print 25 September 2018.

Accepted for publication September 25, 2018.

Funding: Institutional/departmental.

Conflicts of Interest: See Disclosures at the end of the article.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website.

The authors have no conflicts of interest directly relevant to the content of this article within 36 months before submission.

Reprints will not be available from the authors.

Address correspondence to Koji Kawakami, MD, PhD, Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshida Konoecho, Sakyoku, Kyoto 6068501, Japan. Address e-mail to

© 2019 International Anesthesia Research Society
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