Association between preoperative transthoracic echocardiography and clinical outcomes after scheduled hip fracture surgery in geriatric patients

Older patients undergoing hip fracture surgery often experience intraoperative hemodynamic instability despite maintaining cardiac function. Although preoperative hemodynamics in such patients have been demonstrated mainly through invasive monitoring, few studies have addressed hemodynamics based on noninvasively measured parameters. We aimed to investigate preoperative hemodynamic states in older hip fracture patients using transthoracic echocardiography (TTE). The TTE data of patients aged >75 years who underwent hip fracture surgery or elective total hip arthroplasty (THA) between April 1, 2019, and March 31, 2021, were collected. In addition to the baseline characteristics, the TTE data from hip fracture patients were compared with the data of those who underwent THA. The hip fracture patients (n = 167) were significantly older and had lower stroke volume (45.6 vs. 50.9 ml; p < 0.01 ) and stroke index (33.7 vs. 36.6 ml/m2; p < 0.01 ) compared to those who underwent elective THA (n = 44). However, the cardiac output (3.51 vs. 3.48 L/min; p = 0.273 ) and cardiac index (2.6 vs. 2.47 L/min/m2; p = 0.855 ) for both groups were almost identical due to the increase in heart rate in the hip fracture group. Regarding other parameters including ejection fraction, fractional shortening, E/E′, and inferior vena cava diameter, there were no significant differences between the two groups. Our noninvasive TTE investigations suggested that hip fracture patients were volume-depleted, and the hypovolemic status activated the sympathetic nervous system, compensating for their cardiac output. Anesthesiologists must focus on the TTE-assessed parameters reflecting the volume status along with the cardiac function.

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Factors affecting the incidence of surgical site infection after geriatric hip fracture surgery: a retrospective multicenter study

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-019-1449-6 ◽

2019 ◽

Vol 14 (1) ◽

Cited By ~ 5

Author(s):

Xiaopo Liu ◽

Zhijie Dong ◽

Jun Li ◽

Yunbo Feng ◽

Guolong Cao ◽

...

Keyword(s):

Hip Fracture ◽

Surgical Site Infection ◽

Multicenter Study ◽

Geriatric Patients ◽

Operating Time ◽

Site Infection ◽

Hip Fracture Surgery ◽

Geriatric Hip Fracture ◽

Fracture Surgery ◽

Retrospective Multicenter Study

Abstract Background Geriatric hip fracture is a common type of osteoporotic fracture with high mortality and disability; surgical site infection (SSI) can be a devastating complication of this injury. By far, only a few studies identified easily remediable factors to reduce infection rates following hip fracture and less researches have focused on geriatric patients. The objective of this study was to identify potentially modifiable factors associated with SSI following geriatric hip fracture surgery. Methods This retrospective, multicenter study involves three level I hospitals. A total of 1240 patients (60 years or older) underwent hip surgery with complete data were recruited between January 2016 and June 2018. Demographics information, medications and additional comorbidities, operation-related variables, and laboratory indexes were extracted and analyzed. Receiver operating characteristic (ROC) analysis was performed to detect the optimum cut-off value for quantitative data. Univariate and multivariate logistic analysis model were performed respectively to identify the independent predictors. Results Ninety-four (7.58%) patients developed SSI in this study, and 76 (6.13%) had superficial infection, while 18 (1.45%) were diagnosed with deep infection. Results of univariate and multivariate analysis showed age > 79 years (OR, 2.60; p < 0.001), BMI > 26.6 kg/m2 (OR, 2.97; p < 0.001), operating time > 107 min (OR, 2.18; p = 0.001), and ALB < 41.6 g/L (OR, 2.01; p = 0.005) were associated with an increased incidence of SSI; drainage use (OR, 0.57; p = 0.007) could reduce the incidence of wound infection for patients after geriatric hip fracture. Conclusion Accurate modifiable variables, operating time > 107 min, serum albumin < 41.6 g/L, BMI > 26.6 kg/m2, and age > 79 years could be applied to distinguish geriatric patients with high-risk of postoperative surgical site infection.

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