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. 2011 Sep 23:6:49.
doi: 10.1186/1749-799X-6-49.

Pre-operative echocardiogram in hip fracture patients with cardiac murmur--an audit

Prithee Jettoo  1 , Rajesh Kakwani, Shahid Junejo, Imtiyaz Talkhani, Paul Dixon
Affiliations

Pre-operative echocardiogram in hip fracture patients with cardiac murmur--an audit

Prithee Jettoo et al. J Orthop Surg Res. .

Abstract

Background: All hip fracture patients with a cardiac murmur have an echocardiogram as a part of their preoperative work-up in our unit. We performed a retrospective audit to assess the impact of obtaining a pre-operative echocardiogram on the management of hip fracture patients.

Methods: All hip fracture patients (N = 349) between 01/06/08 and 01/06/09 were included in the study. 29 patients had pre-operative echocardiogram (echo group). A computer generated randomised sample of 40 patients was generated from N, 'non-echo' group. Data was obtained from medical records and the Hospital Information Support System (HISS). The groups were compared using Student's t test. Approval was obtained locally from the clinical governance department for this project.

Results: Age and gender distribution were similar in both groups. Indication for echo was an acute cardiac abnormality in 4 cases. 25 patients had echo for no new cardiac problem (indication being cardiac murmur in 23 patients and extensive cardiac history in 2 cases). Cardiology opinion was sought in 5 cases. No patient required cardiac surgery or balloon angioplasty preoperatively. Patients having pre-operative echo had significant delay to surgery (average 2.7 days, range 0-6 days) compared to 'non-echo' group (average 1.1 days, range 0-3 days), (p < 0.001). There was no significant difference in length of stay (p = 0.14) and mortality at 30 days (p = 0.41) between the groups.

Conclusion: We have developed departmental guidelines for expediting echo requests in hip fracture patients with cardiac murmur. A liaison has been established with our cardiology department to prioritise such patients on the Echocardiography waiting list, to prevent unnecessary avoidable delay. Careful patient selection for pre-operative echocardiography is important to avoid unnecessary delay to surgery.

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Figures

Figure 1
Figure 1
Pie chart shows the indication for requests of echocardiogram.
Figure 2
Figure 2
The bar-chart shows the results of echocardiography.
Figure 3
Figure 3
Bar chart illustrates significant delay to surgery between the 2 groups.
See this image and copyright information in PMC

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