In the JournalsPerspective

Unnecessary cardiac consults for hip fracture patients may lead to surgical delays, longer stays

In a retrospective review of hip fracture patients, researchers confirmed the overuse of preoperative cardiac consults without measureable changes in cardiac intervention, which could lead to delays in surgical intervention and longer hospital stays.

Researchers retrospectively identified 266 patients with hip fractures who were admitted to a level 1 trauma center from 2010 to 2012. Researchers recorded patients’ prehospitalization status, including ambulatory status, living situation and comorbidities, and reviewed charts for criteria that would meet the American College of Cardiology (ACC) and the American Heart Association (AHA) guidelines, as well as patients who received cardiac consult.

Results showed 21% of patients received preoperative cardiac consultations. Of the patients who received preoperative cardiac consultations, 29% met the ACC/AHA guidelines for preoperative cardiac evaluations and 71% received unnecessary cardiac consults, according to researchers. Researchers also noted 1.4% of patients who did not receive a cardiac consult met ACC/AHA guidelines.

Andrea Stitgen

Although there was no significant difference in the type of anesthesia received by patients who met ACC/AHA guidelines and patients who did not meet these guidelines, results showed increased monitoring by the anesthesiologist among patients who met these guidelines. According to study results, there was a significantly longer average time to surgery and a significantly longer hospital length of stay among patients who received a preoperative cardiac consult, but did not meet guidelines for cardiac consults. A comparison of patients who received a cardiac consult and patients who did not showed no significant differences in postoperative complications or disposition. – by Casey Tingle

Disclosure: The researchers report no relevant financial disclosures.

In a retrospective review of hip fracture patients, researchers confirmed the overuse of preoperative cardiac consults without measureable changes in cardiac intervention, which could lead to delays in surgical intervention and longer hospital stays.

Researchers retrospectively identified 266 patients with hip fractures who were admitted to a level 1 trauma center from 2010 to 2012. Researchers recorded patients’ prehospitalization status, including ambulatory status, living situation and comorbidities, and reviewed charts for criteria that would meet the American College of Cardiology (ACC) and the American Heart Association (AHA) guidelines, as well as patients who received cardiac consult.

Results showed 21% of patients received preoperative cardiac consultations. Of the patients who received preoperative cardiac consultations, 29% met the ACC/AHA guidelines for preoperative cardiac evaluations and 71% received unnecessary cardiac consults, according to researchers. Researchers also noted 1.4% of patients who did not receive a cardiac consult met ACC/AHA guidelines.

Andrea Stitgen

Although there was no significant difference in the type of anesthesia received by patients who met ACC/AHA guidelines and patients who did not meet these guidelines, results showed increased monitoring by the anesthesiologist among patients who met these guidelines. According to study results, there was a significantly longer average time to surgery and a significantly longer hospital length of stay among patients who received a preoperative cardiac consult, but did not meet guidelines for cardiac consults. A comparison of patients who received a cardiac consult and patients who did not showed no significant differences in postoperative complications or disposition. – by Casey Tingle

Disclosure: The researchers report no relevant financial disclosures.

    Perspective

    The authors have described a phenomenon that is well known to orthopedists — geriatric patients with hip fractures who often undergo unnecessary preoperative cardiac consultations and tests that lead to surgery delays and increased length of hospital stay. They found 71% of patients who had preoperative cardiac consults did not need them based on 2007 American College of Cardiology Foundation and American Heart Association developed guidelines. Furthermore, 53.8% of this group had additional cardiac testing, also presumably unnecessary. These consults and tests were associated with delay to surgery of nearly 1 day and length of stay 2 days longer than those who did not have consults. They found no difference in complications between groups.

    This article nicely quantifies the potential magnitude of unnecessary preoperative testing. However, their results are specific to one institution where all consult decisions were made by hospitalists. The reader should be stimulated to evaluate the status of their preoperative consult and testing protocols at their institutions.

    • William M. Ricci, MD
    • Orthopedics Today Editorial Board member Vice Chair and Trauma Service Chief Department of Orthopaedic Surgery Washington University School of Medicine St. Louis

    Disclosures: Ricci reports no relevant financial disclosures.