Does unnecessary preoperative cardiac consultation and transthoracic echocardiogram delay time to surgery for geriatric hip fractures?

Delays in hip fracture surgery are associated with increased morbidity and mortality. The American Heart Association (AHA) American College of Cardiology (ACC) Clinical Practice Guidelines (CPG) were made to standardize indications for preoperative cardiology consultation and transthoracic echocardiograms (TTE). The purpose of this study is to determine if the AHA/ACC CPG are accurately applied or overused and whether this leads to delay in time to surgery for hip fracture patients at a cardiac specialty hospital. Design: Retrospective review. Setting: Cardiac specialty hospital. Patients: 207 charts from 2021-2023 were reviewed for indications for preoperative cardiology consultations or TTEs according to AHA and ACC CPG in geriatric hip fracture patients. Outcome Measure: Primary: Time to surgery. Secondary: Major adverse cardiac events (MACE) postoperatively. 102 (49.3%) consults were placed despite indications for 41 (40.2%). Of the 38 patients (18.4%) with both a cardiac consult and echocardiogram, 16 (42.1%) of them were indicated. Median time to surgery was not significantly greater for patients receiving cardiology consultation versus those who did not (18.16 vs. 17.12, P-value 0.28, U-statistic 5825). Median time to surgery for patients receiving a TTE was not significantly greater versus those who did not (20.12 vs. 17.11, P-value 0.18, U-statistic 4589). 6 patients experienced a MACE within 30 days postoperatively. Three of 102 patients (2.94%) who received a preoperative cardiac consultation experienced a 30-day MACE compared with three of 105 patients (2.86%) without consultation (Fisher’s exact p ≈ 1.0). Cardiology consultations and TTEs are often used without AHA/ACC CPG indication, wasting hospital and patient resources. At a cardiac specialty hospital, unindicated preoperative cardiac evaluations and TTEs did not delay times to surgery, likely due to cardiology expertise, efficient evaluations, and ample resources. Nonetheless, hospitals should be mindful of consult indications, and AHA/ACC CPG may need to be elucidated.