Sawhney Chhavi, Trikha Vivek, Janani Sai, Bajwa Sukhminder Jit Singh, Sharma Vijay, Khanna Menaal
Department of Anaesthesia, JPNATC, AIIMS, New Delhi, India.
Department of Orthopaedics, JPNATC, AIIMS, New Delhi, India.
Int J Appl Basic Med Res. 2017 Apr-Jun;7(2):104-107. doi: 10.4103/2229-516X.205816.
Hip fractures are associated with a significant risk of morbidity and mortality in the elderly population. Current guidelines propose that these patients should be operated as early as possible. Preoperative cardiac investigations, especially echocardiography, have been considered to delay surgery with few changes in the patient management. The present study has been conducted to evaluate whether preoperative echocardiography improve or worsen the prognosis in such hip trauma surgery.
In this retrospective study, we reviewed the records of elderly patients with hip trauma operated in the tertiary care trauma center of our institute over a period of 1 year. Out of 120 patients, preoperative echocardiography was done in 30 patients. We compared the patients for whom echocardiography was done with the patients who did not undergo echocardiography. Descriptive statistical methods were used to analyze the results and observations.
We observed that preoperative transthoracic echocardiography led to an escalation in cardiac medication in 53% patients when compared with 23.3% in patients who did not undergo echocardiography. No preoperative cardiac intervention was done in any patient. However, there was a delay of 2.5 days in surgery in the echocardiography group as compared to the patients of nonechocardiography group. Rate of regional anesthesia was comparable in both the groups (54% vs. 56.6%).
In the present study, it was observed that echocardiography significantly delays surgery without a significant change in preoperative cardiac medication or anesthesia technique. This may have a potential possible adverse effect on the outcome in geriatric hip trauma which was not observed to a significant limit in the present study as the study was not a longitudinal study. For "fast tracking" of geriatric hip trauma, institutional guidelines should be developed depending on the resources available.
髋部骨折在老年人群中与较高的发病和死亡风险相关。当前指南建议这些患者应尽早接受手术。术前心脏检查，尤其是超声心动图检查，被认为会延迟手术，且对患者管理的改变甚微。本研究旨在评估术前超声心动图检查对这类髋部创伤手术的预后是改善还是恶化。
在这项回顾性研究中，我们回顾了我院三级创伤中心1年内接受髋部创伤手术的老年患者的记录。120例患者中，30例进行了术前超声心动图检查。我们将进行了超声心动图检查的患者与未进行超声心动图检查的患者进行了比较。采用描述性统计方法分析结果和观察数据。
我们观察到，与未进行超声心动图检查的患者中23.3%的比例相比，术前经胸超声心动图检查导致53%的患者心脏用药增加。所有患者均未进行术前心脏干预。然而，与未进行超声心动图检查的患者组相比，超声心动图检查组的手术延迟了2.5天。两组的区域麻醉率相当（54%对56.6%）。
在本研究中，观察到超声心动图显著延迟手术，而术前心脏用药或麻醉技术无显著变化。这可能对老年髋部创伤的预后产生潜在的不利影响，由于本研究并非纵向研究，在本研究中未观察到显著的局限性。对于老年髋部创伤的“快速通道”治疗，应根据可用资源制定机构指南。
