Preoperative cardiac abnormalities associated with one-year mortality in elderly patients undergoing hip fracture surgery: role of focused transthoracic echocardiography

Medicina clinica (English ed.) Pub Date : 2025-09-01 DOI:10.1016/j.medcle.2025.107013

Kaihua Fan , Jianwei Zhang , Ying Gao, Weimei Li

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Abstract

Purpose

We sought to identify preoperative cardiac abnormalities with routine preoperative transthoracic echocardiography (TTE) associated with postoperative mortality in elderly patients undergoing hip fractures surgery, in order to provide reference for focused TTE.

Methods

In this retrospective study, a total of 669 elderly patients (age over 65 years) undergoing hip fractures surgery were included, of which 58 (8.7%) died within one-year after discharge. Cox regression analysis models were used to identify the prognostic cardiac abnormalities of postoperative mortality.

Results

Univariate analysis showed that age (HR 1.065, 95%CI 1.030–1.101; P < 0.001), ASA score (III, IV vs. I, II) (HR 1.855, 95%CI 1.098–3.067; P = 0.022), history of chronic obstructive pulmonary disease (COPD) (HR 4.446, 95%CI 1.909–10.355; P = 0.001) and atrial fibrillation (AF) (HR 3.803, 95%CI 1.803–8.024; P < 0.001), presence of left ventricular ejection fraction (LVEF) < 50% (HR 5.009, 95%CI 2.151–11.665; P < 0.001), left ventricular dilatation (HR 3.813, 95%CI 1.730–8.403; P = 0.001), pulmonary arterial systolic pressure (PASP) > 25 mmHg (HR 4.388, 95%CI 2.492–7.725; P < 0.001), moderate–severe aortic valve stenosis (AS) (HR 4.702, 95%CI 1.471–15.035; P = 0.009) were the dominant predictors of mortality within one-year. The presence of LVEF < 50%, left ventricular dilatation and elevated PASP were proved to be the independent predictors of one-year mortality in elderly patients in multivariate analysis.

Conclusion

Cardiac abnormalities derived from preoperative TTE, namely LVEF < 50%, AS, left ventricular dilatation and elevated PASP had prognostic value for elderly patients undergoing hip fracture surgery. We consider that these indices would be clinically important regarding the preoperative cardiac risk assessment of elderly hip fracture, which may be assessed in the focused TTE.

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老年髋部骨折手术患者术前心脏异常与一年死亡率相关：经胸超声心动图的作用

目的通过术前常规经胸超声心动图（TTE）分析老年髋部骨折患者术前心脏异常与术后死亡率的关系，为针对性的TTE检查提供参考。方法回顾性分析669例65岁以上的老年髋部骨折患者，其中58例（8.7%）在出院后1年内死亡。采用Cox回归分析模型确定心脏预后异常与术后死亡率的关系。结果单因素分析显示，年龄（HR 1.065, 95%CI 1.030-1.101; P < 0.001）、ASA评分（III、IV vs. I、II）（HR 1.855, 95%CI 1.098-3.067; P = 0.022）、慢性阻塞性肺疾病（COPD）病史（HR 4.446, 95%CI 1.909-10.355; P = 0.001）、房颤（AF）（HR 3.803, 95%CI 1.803-8.024; P < 0.001）、左室射血分数（LVEF）和LVEF的存在（HR 5.009, 95%CI 2.151-11.665; P < 0.001）、左室扩张(HR 3.813, 95%CI 1.730-8.403；P = 0.001)、肺动脉收缩压（PASP） > 25 mmHg （HR 4.388, 95%CI 2.492-7.725; P < 0.001）、中重度主动脉瓣狭窄（AS）（HR 4.702, 95%CI 1.471-15.035; P = 0.009）是一年内死亡率的主要预测因素。多因素分析证实LVEF <； 50%、左室扩张和PASP升高是老年患者1年死亡率的独立预测因素。结论术前TTE所致心脏异常，即LVEF <； 50%、AS、左室扩张、PASP升高对老年髋部骨折手术患者有预后价值。我们认为这些指标对于老年人髋部骨折的术前心脏风险评估具有重要的临床意义，可以在重点TTE中进行评估。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Medicina clinica (English ed.)

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