Prediction of Early Postoperative Major Cardiac Events and In-Hospital Mortality in Elderly Hip Fracture Patients: The Role of Different Types of Preoperative Cardiac Abnormalities on Echocardiography Report

Figures & data

Table 1 Clinical Characteristics of the Patients

Patient Characteristics	Value (%)
Patients included	354
Gender (female/male)	270/84
Age (years)	81.97±6.52
Fracture type
Femoral neck	200 (56.5%)
Intertrochanteric	143 (40.4%)
Subtrochanteric	11(3.1%)
Surgery type
Total hip arthroplasty	50 (14.1%)
Hemiarthroplasty	150 (42.4%)
Proximal femoral nail anti-rotation	154 (43.5%)
American Society of Anesthesiologists (ASA) class
ASA I	57 (16.1%)
ASA II	122 (34.5%)
ASA III	128 (36.2%)
ASA IV	47 (13.3%)
Postoperative adverse cardiac events	27 (7.6%)
In-hospital mortality	10 (2.8%)

Table 2 Comparison of Patients with and Without In-Hospital Postoperative Cardiac Complications

Parameters	With Cardiac Events (n=27)	Without Cardiac Events (n=327)	P-value
Age	83.22±4.99	81.88±6.63	0.195
Female, n (%)	22 (81.5%)	248 (75.8%)	0.508
Fracture type			0.934
Femoral neck	15(55.6%)	185(56.5%)	0.918
Intertrochanteric	11(40.7%)	132(40.4%)	0.970
Subtrochanteric	1(3.7%)	10(3.1%)	0.588
Surgery type			0.165
Total hip arthroplasty	7(25.9%)	43(13.2%)	0.122
Hemiarthroplasty	8(29.7%)	142(43.4%)	0.163
Proximal femoral nail anti-rotation	12(44.4%)	142(43.4%)	0.918
Comorbidities on admission
Hypertension	19(70.4%)	218(66.7%)	0.694
Coronary artery disease	12(44.4%)	56(17.1%)	0.001*
Arrhythmia	15(55.6%)	130(39.8%)	0.109
COPD	5(18.5%)	35(10.7%)	0.359
Cerebrovascular disease	7(25.9%)	55(16.8%)	0.351
Diabetes	6(22.2%)	72(22.0%)	0.980
Previous fragility fracture	0(0%)	37(11.3%)	0.129
Chronic kidney disease	2(7.4%)	16(4.9%)	0.908
ASA class			0.188
ASA I	2(7.5%)	55(16.8%)	0.314
ASA II	8(29.6%)	114(34.9%)	0.582
ASA III	10(37.0%)	118(36.1%)	0.921
ASA IV	7(25.9%)	40(12.2%)	0.085
Anesthesiology type			0.409
General anesthesia	1(3.7%)	35 (10.7%)
Regional anesthesia	26 (96.3%)	292 (89.3%)
Echocardiographic abnormality
Left ventricular hypertrophy	5(18.5%)	62(19.0%)	0.955
Moderate-severe aortic valve stenosis	6(22.2%)	14(4.3%)	0.001*
Severe mitral valve stenosis	1(3.7%)	7(2.1%)	0.473
Moderate-severe aortic or mitral valve regurgitation	1(3.7%)	11(3.4%)	0.925
LVEF <50%	3(11.1%)	7(2.1%)	0.036*
PAPs >25mm Hg	6(22.2%)	71(21.7%)	0.951
Pericardial effusion	1(3.7%)	14(4.3%)	0.886

Note: *Statistical significance.

Abbreviations: COPD, chronic obstructive pulmonary disease; ASA, American Society of Anesthesiologists; LVEF, left ventricle ejection fraction; PAPs, systolic pulmonary artery pressure.

Table 3 Multivariate Analysis for the Prediction of In-Hospital Postoperative Cardiac Complications

Parameters	Odds Ratio	Confidence Interval (CI)	P-value
CAD	3.281	1.332–8.079	0.010
Moderate-severe aortic stenosis	5.656	1.869–17.117	0.002
LVEF <50%	1.860	0.368–9.404	0.453

Abbreviations: CAD, coronary artery disease; LVEF, left ventricle ejection fraction.

Table 4 Characteristics of Hip Fracture Patients Classified by Survival Status Within Hospitalization

Parameters	Survivors (n=344)	Non-Survivors (n=10)	P-value
Age	80.99±6.48	86.42±4.66	0.005*
Female, n (%)	262 (76.2%)	8 (80%)	0.779
Fracture type			0.197
Femoral neck	197(57.3%)	3 (30%)	0.164
Intertrochanteric	136 (39.5%)	7 (70%)	0.108
Subtrochanteric	11(3.2%)	0 (0%)	1.000
Surgery type			0.196
Total hip arthroplasty	50 (14.6%)	0 (0%)	0.632
Hemiarthroplasty	147 (42.7%)	3 (30%)	0.401
Proximal femoral nail anti-rotation	147 (42.7%)	7 (70%)	0.164
Comorbidities on admission
Hypertension	233 (67.7%)	4(40%)	0.134
Coronary artery disease	60(17.4%)	8(80%)	0.001*
Arrhythmia	136(39.5%)	9(90%)	0.004*
COPD	36(10.5%)	4(40%)	0.016*
Cerebrovascular disease	62(18%)	0(0%)	0.291
Diabetes	76(22.1%)	2(20.0%)	0.875
Previous fragility fracture	37(10.8%)	0(0%)	0.568
Chronic kidney disease	17(4.9%)	1(10.0%)	0.522
ASA class			0.071
ASA I	57(16.6%)	0(0%)	0.333
ASA II	120(34.9%)	2(20.0%)	0.523
ASA III	124(36.0%)	4(40.0%)	0.798
ASA IV	43(12.5%)	4(40.0%)	0.031*
Anesthesiology type			0.583
General anesthesia	36 (10.5%)	0 (0%)
Regional anesthesia	308 (89.5%)	10 (100%)
Echocardiographic abnormality
Left ventricular hypertrophy	65(18.9%)	2(20.0%)	0.930
Moderate-severe aortic valve stenosis	16(4.7%)	4(40%)	0.001*
Severe mitral valve stenosis	7(2.0%)	1(10%)	0.207
Moderate-severe aortic or mitral valve regurgitation	12(3.5%)	0(0%)	0.705
PAPs >25mm Hg	72(20.9%)	5(50%)	0.071
Left ventricular ejection fraction <50%	7(2.0%)	3(30%)	0.001*
Pericardial effusion	14(4.1%)	1(10%)	0.355

Note: *Statistical significance.

Abbreviations: COPD, chronic obstructive pulmonary disease; ASA, American Society of Anesthesiologists; LVEF, left ventricle ejection fraction; PAPs, systolic pulmonary artery pressure.

Table 5 Multivariate Analysis for the Prediction of In-Hospital Mortality

Parameters	Odds Ratio	Confidence Interval (CI)	P-value
Age	1.264	1.047–1.527	0.015
Coronary artery disease	19.290	2.002–185.885	0.010
COPD	1.991	0.313–12.683	0.466
Arrhythmia	5.186	0.482–55.799	0.174
ASA 4	1.552	0.260–9.275	0.629
Moderate-severe aortic stenosis	7.164	1.988–51.413	0.040
LVEF <50%	8.803	1.115–69.472	0.039

Abbreviations: COPD, chronic obstructive pulmonary disease; ASA, American Society of Anesthesiologists; LVEF, left ventricle ejection fraction.