Focused Transthoracic Echocardiography in Hip Fracture Surgery Patients - Abstract
Despite advances in medical care, hip fracture surgery remains one of the commonest and highest risk surgical procedures (10% in-hospital mortality and 25% at one year), representing a major economic cost to our community and a World health care burden. Hip fracture patients are usually elderly and chronic cardiovascular disease is common. Due to urgency of surgery, frequent patient cognitive impairment and limitations in health care resources, cardiac disease is often inadequately treated and remains the leading cause of mortality. Preoperative transthoracic echocardiography (TTE) performed in the echocardiography
laboratory non-invasively alerts treating physicians to cardiac disease but may result in a delay which is associated with worse outcome and hence is usually restricted to selected patients. Anesthesiologists have been increasingly performing their own ‘goal-focused TTE’, an abbreviated examination which really forms an extension of clinical examination, which also alerts the anesthesiologist to abnormal hemodynamic states such as hypovolemia, ventricular failure and vasodilation, thus guiding appropriate hemodynamic treatment and monitoring before, during and after surgery. Recent published data showed a major influence of goal-focused TTE on management of patients requiring hip fracture and other non-cardiac surgery. Further proof of concept data has revealed that mortality may be reduced in hip fracture surgery patients who receive a preoperative focused transthoracic echocardiography by the anesthesiologist. This technology has the potential to drastically improve the medical care of patients at high risk of cardiac disease requiring non-cardiac surgery. Recently, several guidelines from learned societies of echocardiography have been published on recommendations for training and practice of focused TTE by non-cardiologists for ultrasound assisted examination. Focused TTE requires significant training and funding and to justify this important and rapid shift in medical practice, there is a need for high quality outcome studies to be performed. Equally important are efficient teaching methods and a robust mechanism to ensure minimum standards of proficiency to minimize the recognised potential harm from erroneous conclusions drawn from misinterpretation of data.