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Cardiac overscreening hip fracture patients

BACKGROUND: The aim of this study was to prospectively investigate the adherence to the American College of Cardiology (ACC) and the American Heart Association guidelines for perioperative assessment of patients with hip fracture in daily clinical practice and how this might affect outcome. METHODS:...

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Autores principales: Smeets, S. J. M., van Wunnik, B. P. W., Poeze, M., Slooter, G. D., Verbruggen, J. P. A. M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6942037/
https://www.ncbi.nlm.nih.gov/pubmed/31471640
http://dx.doi.org/10.1007/s00402-019-03270-z
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author Smeets, S. J. M.
van Wunnik, B. P. W.
Poeze, M.
Slooter, G. D.
Verbruggen, J. P. A. M.
author_facet Smeets, S. J. M.
van Wunnik, B. P. W.
Poeze, M.
Slooter, G. D.
Verbruggen, J. P. A. M.
author_sort Smeets, S. J. M.
collection PubMed
description BACKGROUND: The aim of this study was to prospectively investigate the adherence to the American College of Cardiology (ACC) and the American Heart Association guidelines for perioperative assessment of patients with hip fracture in daily clinical practice and how this might affect outcome. METHODS: This prospective cohort study from Maastricht University Medical Centre included 166 hip fracture patients within a 3-year inclusion period. The preoperative cardiac screening and adherence to the ACC/AHA guideline were analyzed. Cardiac risk was classified as low, intermediate and high risk. Secondary outcome measurements were delay to surgery, perioperative complications and in-hospital, 30-day, 1-year and 2-year mortality. RESULTS: According to the ACC/AHA guideline, 87% of patients received correct preoperative cardiac screening. The most important reason for incorrect preoperative cardiac screening was overscreening (> 90%). Multivariate analysis showed that a cardiac consultation (p = 0.003) and overscreening (p = 0.02) as significant predictors for increased delay to surgery, while age, sex, previous cardiac history and preoperative mobility were not. High risk patients had in comparison with low risk patients a significantly higher relative risk ratio for in-hospital mortality (RR 6, 95% CI 2–17). Multivariate analysis showed that a previous cardiac history and increased delay to surgery were predictors for early mortality. High age and previous cardiac history were risk factors for late mortality. CONCLUSION: Preoperative cardiac screening for hip fracture patients in adherence to the ACC/AHA guideline is associated with a diminished use of preoperative resources. Overscreening leads to greater delay to surgery, which poses a risk for perioperative complications and early mortality. LEVEL OF EVIDENCE: II.
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spelling pubmed-69420372020-01-16 Cardiac overscreening hip fracture patients Smeets, S. J. M. van Wunnik, B. P. W. Poeze, M. Slooter, G. D. Verbruggen, J. P. A. M. Arch Orthop Trauma Surg Trauma Surgery BACKGROUND: The aim of this study was to prospectively investigate the adherence to the American College of Cardiology (ACC) and the American Heart Association guidelines for perioperative assessment of patients with hip fracture in daily clinical practice and how this might affect outcome. METHODS: This prospective cohort study from Maastricht University Medical Centre included 166 hip fracture patients within a 3-year inclusion period. The preoperative cardiac screening and adherence to the ACC/AHA guideline were analyzed. Cardiac risk was classified as low, intermediate and high risk. Secondary outcome measurements were delay to surgery, perioperative complications and in-hospital, 30-day, 1-year and 2-year mortality. RESULTS: According to the ACC/AHA guideline, 87% of patients received correct preoperative cardiac screening. The most important reason for incorrect preoperative cardiac screening was overscreening (> 90%). Multivariate analysis showed that a cardiac consultation (p = 0.003) and overscreening (p = 0.02) as significant predictors for increased delay to surgery, while age, sex, previous cardiac history and preoperative mobility were not. High risk patients had in comparison with low risk patients a significantly higher relative risk ratio for in-hospital mortality (RR 6, 95% CI 2–17). Multivariate analysis showed that a previous cardiac history and increased delay to surgery were predictors for early mortality. High age and previous cardiac history were risk factors for late mortality. CONCLUSION: Preoperative cardiac screening for hip fracture patients in adherence to the ACC/AHA guideline is associated with a diminished use of preoperative resources. Overscreening leads to greater delay to surgery, which poses a risk for perioperative complications and early mortality. LEVEL OF EVIDENCE: II. Springer Berlin Heidelberg 2019-08-31 2020 /pmc/articles/PMC6942037/ /pubmed/31471640 http://dx.doi.org/10.1007/s00402-019-03270-z Text en © The Author(s) 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Trauma Surgery
Smeets, S. J. M.
van Wunnik, B. P. W.
Poeze, M.
Slooter, G. D.
Verbruggen, J. P. A. M.
Cardiac overscreening hip fracture patients
title Cardiac overscreening hip fracture patients
title_full Cardiac overscreening hip fracture patients
title_fullStr Cardiac overscreening hip fracture patients
title_full_unstemmed Cardiac overscreening hip fracture patients
title_short Cardiac overscreening hip fracture patients
title_sort cardiac overscreening hip fracture patients
topic Trauma Surgery
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6942037/
https://www.ncbi.nlm.nih.gov/pubmed/31471640
http://dx.doi.org/10.1007/s00402-019-03270-z
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