Unnecessary Pre-Operative Cardiology Evaluation and Transthoracic Echocardiogram Delays Time to Surgery for Geriatric Hip Fractures

OBJECTIVE Delays to surgery for geriatric hip fracture patients are associated with increased morbidity and mortality. The American Heart Association (AHA) and American College of Cardiology (ACC) Clinical practice guidelines (CPG) were created to standardize pre-operative cardiology consultation and transthoracic echocardiogram (TTE). This study's purpose is to determine if these practices are over utilized and delay time to surgery at a safety net hospital. DESIGN Retrospective review. SETTING Level 1 trauma center and safety net hospital PATIENTS:: Charts were reviewed for indications of preoperative cardiology consultation or TTE per AHA and ACC CPG in 412 admitted geriatric hip fracture patients. INTERVENTION Criteria meeting the AHA/ACC guidelines for preoperative TTE andcardiac consultations. MAIN OUTCOME MEASUREMENTS Time to surgical intervention RESULTS:: Despite 17.7% of patients meeting criteria, 44.4% of patients received cardiology consultation. Of those patients, 33.8% met criteria for receiving preoperative TTE, but 89.4% received one. Time to surgery was greater for patients receiving cardiology consultation (25.42±14.54 hours, p-value <0.001) versus those who did not (19.27±13.76, p-value <0.001), and for those receiving preoperative TTE (26.00±15.33 hours, p-value <0.001) versus those who did not (18.94±12.92, p-value <0.001). CONCLUSIONS Cardiology consultation and TTE are frequently utilized against AHA/ACC CPG. These measures are expensive and delay surgery, which can increase morbidity and mortality. These findings persisted despite limited resources available in a safety net hospital. Hospitals should improve adherence to CPG, or modify protocols. LEVEL OF EVIDENCE Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.