Ellenbogen Michael I, Brotman Daniel J, Prichett Laura, Li Ximin, Feldman Leonard S
Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland.
Biostatistics, Epidemiology, and Data Management (BEAD) Core, Johns Hopkins School of Medicine, Baltimore, Maryland.
J Hosp Med. 2019 Apr;14(4):224-228. doi: 10.12788/jhm.3142.
Hip fracture is a common reason for urgent inpatient surgery. In the past few years, several professional societies have identified preoperative echocardiography and stress testing for noncardiac surgeries as low-value diagnostics. We utilized data on hospitalizations with a primary diagnosis of hip fracture surgery between 2011 and 2015 from the State Inpatient Databases (SID) of Maryland, New Jersey, and Washington, combined with data on hospital characteristics from the American Hospital Association (AHA). We found that the rate of preoperative ischemic testing is surprisingly but encouragingly low (stress tests 1.1% and cardiac catheterizations 0.5%), which is consistent with studies evaluating the outpatient utilization of these tests for low-and intermediate-risk surgeries. The rate of echocardiograms was 12.6%, which was higher than other published reports. Our findings emphasize the importance of ensuring that quality improvement efforts are directed toward areas where quality improvement is, in fact, needed.
髋部骨折是紧急住院手术的常见原因。在过去几年中，几个专业学会已将非心脏手术的术前超声心动图和压力测试确定为低价值诊断方法。我们利用了来自马里兰州、新泽西州和华盛顿州住院病人数据库（SID）中2011年至2015年以髋部骨折手术为主要诊断的住院数据，并结合了美国医院协会（AHA）的医院特征数据。我们发现，术前缺血性检查的比率低得出乎意料但令人鼓舞（压力测试为1.1%，心导管插入术为0.5%），这与评估这些检查在低风险和中等风险手术门诊使用情况的研究结果一致。超声心动图检查的比率为12.6%，高于其他已发表的报告。我们的研究结果强调了确保质量改进工作针对实际需要改进的领域的重要性。
