BACKGROUND

Timely surgical intervention for hip fractures is critical, as

delays beyond 24 hours after admission is associated

with increased morbidity and mortality. (1)

• A study reviewing hip fracture morbidity & mortality at

our institution revealed time to the Operating Room

(OR) exceeds this. (Fig. 2)

• One frequently cited contributor to increased wait times

is the use of preoperative Transthoracic

Echocardiograms (TTEs).

• This study reviews the subset of patients receiving

preoperative TTEs and examines the frequency of

findings requiring a medically necessary delay to

surgery; with the aim to develop and implement a

standardized hip fracture protocol at our institution. (2)

 

OBJECTIVE

This project is to assess the medical necessity of

preoperative TTEs in hip fracture patients and to

determine the frequency of findings requiring a delay to

surgery. The target is a reduction in time to surgery

through a standardized protocol clarifying when TTEs

are necessary for preoperative optimization.

 

METHODS

We conducted a retrospective chart review of a subset containing

42 patients admitted with hip fractures between Jan. 2016 and

Dec. 2020 who underwent TTE prior to surgery. (Fig. 1)

Key metrics included:

• Date of admission and surgery

• Presence of a cardiac consult

• Significant TTE findings (e.g., new regional wall motion

abnormalities, severe aortic stenosis) (Fig. 4)

• Other preoperative interventions (e.g., cardiac catheterization or

valvuloplasty)

• Consult meeting external criteria. (Fig. 3)

 

CONCLUSION

Preoperative cardiac consults and TTEs significantly delay

surgery in hip fracture patients. In our cohort, 38% (16/42)

underwent these evaluations without meeting the external

criteria (Fig. 1), extending the average time to surgery from

47.76 hours to 82.34 hours for patients who received a TTE.

(Fig. 2) Since delays beyond 24 hours are associated with

increased morbidity, mortality and length of hospitalization,

implementing a protocol clarifying when to obtain cardiac

evaluations may improve patient outcomes.

 

FUTURE DIRECTIONS

Protocol Development and Implementation: Create a

standardized hip fracture pathway modeled after UCSF’s protocol

to guide the appropriate use of cardiac consults and TTEs.