DALLAS — Surgical repair of hip fracture in the elderly is linked to a high risk of postoperative MI or death—a reality not reflected in current American College of Cardiology/American Heart Association preoperative cardiovascular evaluation guidelines, Dr. Jeanne Huddleston said at the annual meeting of the Society of Hospital Medicine.
The guidelines lump all orthopedic surgical procedures in an intermediate-risk category, meaning their combined risk of postoperative MI or death is expected to be less than 5%. That's true of elective total hip arthroplasty, but hip fracture repair is different, said Dr. Huddleston, a hospitalist at the Mayo Clinic, Rochester, Minn., and former society president.
She presented a population-based retrospective study of 1,197 patients who underwent repair of a fractured hip and 693 who had hip replacement. During a mean hospital stay of 8.9 days, the incidence rates of postoperative MI, heart failure, and mortality were markedly lower in the elective hip arthroplasty group (see chart). Moreover, the combined 1-year rate of MI and all-cause mortality was 34.2% in patients undergoing fracture repair, versus 7.5% in the arthroplasty group. Adjusting for age, gender, and American Society of Anesthesiologists physical status classification, racture repair patients were 3.6-fold more likely to have an MI or die within a year postsurgery.
Hip fracture repair is typically done on an urgent basis, but doesn't fall within the definition of “emergency” surgery in guidelines. Since it's considered nonemergent, physicians can take up to 48 hours postfracture to optimize cardiac status—a sound strategy given the high CV risk, according to Dr. Huddleston.
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