Unnecessary preoperative echocardiography in an asymptomatic, physically active 72-year-old woman with a hip fracture resulted in a 48-hour delay in surgical intervention.
Does routine preoperative echocardiography improve outcomes or cause unnecessary delays in asymptomatic, stable patients undergoing non-cardiac surgery?
Routine preoperative echocardiography in asymptomatic, stable patients undergoing non-cardiac surgery provides minimal clinical benefit and can cause harmful surgical delays, especially in resource-limited settings.
Preoperative echocardiography has long been used as an effective diagnostic tool in the preoperative assessment of surgical candidates. In elderly patients, hip fractures represent a critical medical emergency with a high risk of complications that can occur if not addressed promptly. Unnecessary preoperative investigations may lead to delays and potentially compromise the quality of patient care. The motivation to evaluate the utility of preoperative echocardiography in select clinical scenarios, particularly in low- and middle-income countries (LMICs) where resources are limited, arose from the case of a 72-year-old female who presented to a tertiary hospital in Nairobi, Kenya, with a right-sided intertrochanteric hip fracture following a traumatic fall. She was physically active with metabolic equivalents of tasks (METs) ≥4 and had no significant history of cardiovascular symptoms or risk factors. Preoperative electrocardiogram (ECG) was performed and revealed T-wave inversions in leads V5-V6, prompting a request for an echocardiogram. Technical difficulties led to a delay in the procedure, postponing surgery. The patient was later deemed fit for surgery by the cardiology team without the need for an echocardiogram, and she successfully underwent an open reduction and internal fixation (ORIF). Routine preoperative echocardiography serves minimal clinical benefit in asymptomatic and stable patients undergoing non-cardiac surgery. In such patients, metabolic equivalents of tasks (METs ≥4), normal N-terminal pro-B-type natriuretic peptide (NT-proBNP), and cardiac troponin levels can serve as sufficiently reliable tools for preoperative cardiovascular evaluation. Unnecessary echocardiograms have been associated with surgical delays, prolonged hospital stays, and increased healthcare costs. Evidence-based medical practices guided by established guidelines are essential in ensuring efficient patient care. In addition to obtaining a detailed patient history and thorough physical examination, it is also crucial to inform clinicians of the selective yet valuable role of echocardiograms in the preoperative assessments of surgical patients to prevent futile interventions and delays.
Khakhar et al. (Thu,) conducted a editorial in Intertrochanteric hip fracture (n=1). Preoperative echocardiography was evaluated on Surgical delay. Unnecessary preoperative echocardiography in an asymptomatic, physically active 72-year-old woman with a hip fracture resulted in a 48-hour delay in surgical intervention.