Does preoperative dipyridamole-thallium scanning reduce 90-day cardiac complications and 1-year mortality in patients with femoral neck fractures undergoing hemiarthroplasty?

Background This study aimed to evaluate the effect of dipyridamole-thallium scanning (DTS) on the rates of 90-day cardiac complications and 1-year mortality in patients with a femoral neck fracture treated with hemiarthroplasty. Methods Between 2008 and 2015, 844 consecutive patients who underwent cemented or cementless hemiarthroplasty were identified from the database of a single level-one medical center. One-hundred and thirteen patients (13%) underwent DTS prior to surgery, and 731 patients (87%) did not. Patient characteristics, comorbidities, surgical variables, and length of the delay until surgery were recorded. A propensity score-matched cohort was utilized to reduce recruitment bias in a 1:3 ratio of DTS group to control group, and multivariate logistic regression was performed to control confounding variables. Results The incidence of 90-day cardiac complications was 19.5% in the DTS group and 15.6% in the control group (p = 0.343) among 452 patients after propensity score-matching. The 1-year mortality rate (10.6% vs 13.3%, p = 0.462) was similar in the two groups. In the propensity score-matched patients, utilization of DTS was not associated with a reduction in the rate of 90-day cardiac complications (matched cohort, adjusted odds ratio [aOR] = 1.32; 95% confidence interval [CI] 0.75–2.33, p = 0.332) or the 1-year mortality rate (aOR = 0.62; 95% CI 0.27–1.42, p = 0.259). Risk factors for cardiac complications included an American Society of Anesthesiologists grade ≥ 3 (OR 3.19, 95% CI 1.44–7.08, p = 0.004) and pre-existing cardiac comorbidities (OR 5.56, 95% CI 3.35–9.25, p < 0.001). Risk factors for 1-year mortality were a long time to surgery (aOR 1.15, 95% CI 1.06–1.25, p = 0.001), a greater age (aOR 1.05, 95% CI 1.00 to 1.10, p = 0.040), a low body mass index (BMI; aOR 0.89, 95% CI 0.81–0.98, p = 0.015), and the presence of renal disease (aOR 4.43, 95% CI 1.71–11.46, p = 0.002). Discussion Preoperative DTS was not associated with reductions in the rates of 90-day cardiac complications or 1-year mortality in patients with a femoral neck fracture undergoing hemiarthroplasty. The necessity for DTS should be re-evaluated in elderly patients with femoral neck fractures, given that this increases the length of the delay until surgery. Level of evidence Prognostic level III

Dipyridamole-thallium scanning doesn't reduce 90-day cardiac complications and mortality in femoral neck fracture patients undergoing hemiarthroplasty: a propensity-score-matched analysis in an Asian population

Background: This study aimed to evaluate the effect of dipyridamole-thallium scanning on 90-day cardiac complications and mortality in patients with femoral neck fracture treated with hemiarthroplasty.Methods: Between 2008 and 2015, 844 consecutive patients undergoing cemented or cementless hemiarthroplasty were identified from the database of a single level-one medical center. One-hundred and thirteen patients (13.4%) underwent the dipyridamole-thallium scan test prior to surgery, and 731 patients (86.6%) did not. Patient characteristics, comorbidities, surgical variables, and duration to surgery were recorded. Multivariate logistic regression was performed, and a propensity-score-matched cohort was identified in order to determine whether dipyridamole-thallium scanning was associated with 90-day cardiac complications and mortality.Results: The incidence of 90-day cardiac complications was 19.47% in the thallium scan group and 11.58% in the non-thallium scan group (p = 0.343) among 452 patients after propensity score-matching. The 90-day mortality rate was similar in the two groups (0.88% vs. 1.18%, p = 0.795). In the propensity score-matched patients, utilization of the dipyridamole-thallium scan was irrelevant to cardiac complications (matched cohort, adjusted odds ratio [OR] = 1.32; 95% confidence interval [CI] 0.75 to 2.33) or mortality (adjusted OR = 0.75; 95% CI 0.08 to 6.71) within 90 days. Risk factors for cardiac complications were an American Society of Anesthesiologists grade 3 (OR 3.19, 95% CI 1.44 to 7.08) and pre-existing cardiac comorbidities (OR 5.56, 95% CI 3.35 to 9.25). Discussion: Preoperative dipyridamole-thallium scanning was not associated with reductions in 90-day cardiac complications and mortality in patients with femoral neck fracture undergoing hemiarthroplasty. The necessity for dipyridamole-thallium scanning should be re-evaluated in elderly patients with femoral neck fractures, given that this increases the duration to surgery.

Does preoperative dipyridamole-thallium scanning reduce 90-day cardiac complications and mortality in patients with femoral neck fractures undergoing hemiarthroplasty?

Background: This study aimed to evaluate the effect of dipyridamole-thallium scanning on 90-day cardiac complications and mortality in patients with femoral neck fracture treated with hemiarthroplasty. Methods : Between 2008 and 2015, 844 consecutive patients undergoing cemented or cementless hemiarthroplasty were identified from the database of a single level-one medical center. One-hundred and thirteen patients (13.4%) underwent the dipyridamole-thallium scan test prior to surgery, and 731 patients (86.6%) did not. Patient characteristics, comorbidities, surgical variables, and duration to surgery were recorded. Multivariate logistic regression was performed, and a propensity-score-matched cohort was identified in order to determine whether dipyridamole-thallium scanning was associated with 90-day cardiac complications and mortality. Results: The incidence of 90-day cardiac complications was 19.47% in the thallium scan group and 11.58% in the non-thallium scan group ( p = 0.343) among 452 patients after propensity score-matching. The 90-day mortality rate was similar in the two groups (0.88% vs. 1.18%, p = 0.795). In the propensity score-matched patients, utilization of the dipyridamole-thallium scan was not associated with cardiac complications (matched cohort, adjusted odds ratio [OR] = 1.32; 95% confidence interval [CI] 0.75 to 2.33) or mortality (adjusted OR = 0.75; 95% CI 0.08 to 6.71) within 90 days. Risk factors for cardiac complications were an American Society of Anesthesiologists grade 3 (OR 3.19, 95% CI 1.44 to 7.08) and pre-existing cardiac comorbidities (OR 5.56, 95% CI 3.35 to 9.25). Discussion : Preoperative dipyridamole-thallium scanning was not associated with reductions in 90-day cardiac complications and mortality in patients with femoral neck fracture undergoing hemiarthroplasty. The necessity for dipyridamole-thallium scanning should be re-evaluated in elderly patients with femoral neck fractures, given that this increases the duration to surgery.

Preoperative dipyridamole-thallium scanning did not reduce 90-day cardiac complications and mortality in patients with femoral neck fractures undergoing hemiarthroplasty

Background: Patients with hip fractures have risk factors that increase the likelihood of postoperative cardiac complications and mortality. This study aimed to evaluate the effect of dipyridamole-thallium scanning on 90-day cardiac complications and mortality in patients with femoral neck fracture treated with hemiarthroplasty. Methods: Between 2008 and 2015, 844 consecutive patients undergoing cemented or cementless hemiarthroplasty were identified from the database of a single level-one medical center. One-hundred and thirteen patients (13.4%) underwent the dipyridamole-thallium scan test prior to surgery, and 731 patients (86.6%) did not. Patient characteristics, comorbidities, surgical variables, and duration to surgery were recorded. Multivariate logistic regression was performed, and a propensity-score-matched cohort was identified in order to determine whether dipyridamole-thallium scanning was associated with 90-day cardiac complications and mortality.Results: The incidence of 90-day cardiac complications was 19.47% in the thallium scan group and 11.58% in the non-thallium scan group (p = 0.343) among 452 patients after propensity score-matching. The 90-day mortality rate was similar in the two groups (0.88% vs. 1.18%, p = 0.795). In the propensity score-matched patients, utilization of the dipyridamole-thallium scan was not associated with cardiac complications (matched cohort, adjusted odds ratio [OR] = 1.32; 95% confidence interval [CI] 0.75 to 2.33) or mortality (adjusted OR = 0.75; 95% CI 0.08 to 6.71) within 90 days. Risk factors for cardiac complications were an American Society of Anesthesiologists grade 3 (OR 3.19, 95% CI 1.44 to 7.08) and pre-existing cardiac comorbidities (OR 5.56, 95% CI 3.35 to 9.25). Discussion: Preoperative dipyridamole-thallium scanning was not associated with reductions in 90-day cardiac complications and mortality in patients with femoral neck fracture undergoing hemiarthroplasty. The necessity for dipyridamole-thallium scanning should be re-evaluated in elderly patients with femoral neck fractures, given that this increases the duration to surgery.