Abstract
Aim
To investigate any intra-operative alteration in management in those patients who had a pre-operative echocardiogram, a retrospective study for one year (March 2004 to February 2005) was carried out at West Middlesex University Hospital.
Results
Total number of 176 hip fractures, echocardiogram was done pre-operatively in 22 patients (12.5%). The request for echo was given by the anaesthetic team in 18/22 patients, the commonest reason for request being a cardiac murmur detected clinically in 20/22 patients.
There was a delay in surgery more than 24 hours in 17/22 patients who had an echocardiogram (77%) compared to a 38% delay in patients who did not.
The echocardiogram findings showed significant aortic stenosis in 4/22 (18%). There was no cancellation of surgery due to echocardiogram findings Five had general anaesthetic.
There was alteration in intra-operative management in two out of the 22 patients (8%) Invasive arterial monitoring was used in those two patients. None had intra-operative complications or ITU/HDU care post-operatively. Post-operatively 6/22 developed complications. 15/22 patients had a delay in discharge (68%) of more than 21 days compared to the 41% delay in patients who did not have an echocardiogram. We had a mortality rate of 22.7% (5/22) in these patients at 1 month compared to a mortality rate of 12% in patients without echocardiogram.
Discussion
There was no significant alteration in intra-operative management in patients who had an echo as part of optimisation for surgery. Echocardiograms were requested without clear guidelines, was unnecessary in majority, resulted in delay in surgery and discharge with significant increase in mortality and morbidity in these patients compared to patients without echocardiogram.
