Department of Anaesthesia and Pain Management Consultant Cardiothoracic Surgeon, Department of Surgery, Royal Melbourne Hospital, Melbourne, Australia.
Anaesthesia. 2012 Nov;67(11):1202-9. doi: 10.1111/j.1365-2044.2012.07300.x. Epub 2012 Sep 5.
Hip fracture surgery is associated with a high rate of mortality and morbidity; heart disease is the leading cause and is often unrecognised and inadequately treated. Pre-operative focused transthoracic echocardiography by anaesthetists frequently influences management, but mortality outcome studies have not been performed to date. Mortality over the 12 months after hip fracture surgery, in 64 patients at risk of cardiac disease who received pre-operative echocardiography, was compared with 66 randomised historical controls who did not receive echocardiography. Mortality was lower in the group that received echocardiography over the 30 days (4.7% vs 15.2%, log rank p=0.047) and 12 months after surgery (17.1% vs 33.3%, log rank p=0.031). Hazard of death was also reduced with pre-operative echocardiography over 12 months after adjustment for known risk factors (hazard ratio 0.41, 95% CI 0.2-0.85, p=0.016). Pre-operative echocardiography was not associated with a delay in surgery. These data support a randomised controlled trial to confirm these findings.
髋部骨折手术相关的死亡率和发病率很高；心脏病是主要原因，且常常未被识别和治疗不足。麻醉医师进行的术前经胸超声心动图检查常影响治疗管理，但迄今尚未开展死亡率预后研究。对接受术前超声心动图检查的 64 例有心脏疾病风险的患者，与未接受超声心动图检查的 66 例随机历史对照患者相比，在髋部骨折手术后 12 个月的死亡率。在术后 30 天（4.7%比 15.2%，对数秩检验 p=0.047）和 12 个月（17.1%比 33.3%，对数秩检验 p=0.031）时，接受超声心动图检查的患者死亡率较低。在校正已知危险因素后，在手术后 12 个月时，超声心动图检查的死亡风险也降低（风险比 0.41，95%CI 0.2-0.85，p=0.016）。术前超声心动图检查与手术延迟无关。这些数据支持开展一项随机对照试验来证实这些发现。
