The medical and economic impact of preoperative cardiac testing in elderly patients with hip fractures

Abstract

Purpose: To assess the medical and economic impact of preoperative cardiac testing (stress thallium imaging or echocardiography) on the treatment of elderly patients with hip fractures.

Materials and methods: 235 consecutive patients over the age of 60 treated for a hip fracture (236 fractures) (OTA 31) at a single Level I trauma centre were identified from a prospective orthopaedic trauma database and studied as part of a retrospective cohort series. 35 (15%) had cardiac testing prior to treatment of their hip fracture. The indication for testing was a newly diagnosed cardiac abnormality in 16 of these cases and a prior history of cardiovascular disease without an acute cardiac problem in 19.

Results: Cardiac evaluation did not change the orthopaedic management in any case. No patient underwent cardiac surgery or coronary angioplasty as a result of the testing. In 48% of cases, cardiac testing did not lead to new medical treatment. In 52%, recommendations were only made for medical management of previously known cardiac disease. Patients who had cardiac testing had a significantly greater average delay to surgery (3.3 days) than those who did not (1.9 days), (P<.001). The cost of preoperative cardiac testing totalled more than $44,000 for the 35 patients.

Discussion and conclusion: Preoperative cardiac testing did not lead to changes in perioperative orthopaedic or medical management of elderly patients with hip fractures. Patients undergoing testing had a significant delay to surgery. Extrapolated to the population of elderly hip fracture patients in the United States (250,000 annually), preoperative cardiac testing (performed in 15% of cases) would cost nearly $47,000,000 annually. Preoperative cardiac testing may add profoundly to the healthcare costs associated with treating this population of patients without influencing orthopaedic or medical management.