The occasional practice of doing cardiac stress testing before hip fracture surgery has “limited value,” according to a study presented by S. Andrew Sems, MD, at the recent Orthopaedic Trauma Association annual meeting. Among patients who had the tests, only 1.8 percent underwent cardiac intervention as a result. In addition, testing resulted in longer times to surgery and longer hospital stays.

AAOS Now

Published 12/1/2007
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Annie Hayashi

Cardiac testing before hip fracture surgery of little value

Testing delays surgery, doesn’t lead to interventions

S. Andrew Sems, MD

Retrospective, case-controlled study
The retrospective, case-controlled study of 973 patients who sustained proximal femur fractures between the years 2001 and 2006 involved 54 patients (average age 81.7 years) who had preoperative cardiac stress testing—dobutamine stress echocardiograms (DSE) or sestamibi scans—and 919 patients (average age 83.2 years) who had no testing (control group).

“We noticed that about 5 percent of our patients were undergoing cardiac stress tests prior to hip fracture fixation,” Dr. Sems said. “We were concerned about the possibility of a significant delay to surgery when these tests were done. We also noticed that even when the tests were ‘positive’ for ischemia, intervention was rare—making the tests even less useful and delaying the surgery.”

An extra day to surgery, 2 more in the hospital
The analysis revealed the following results:

  • Of the 54 patients who underwent cardiac stress testing, one patient (who had DSE testing) had cardiac bypass surgery prior to hip fixation and died within 2 months.
  • None of the patients who had sestamibi scans underwent any cardiac interventions.
  • DSE testing was positive for ischemia in 12 patients; sestamibi scans were positive in one patient.
  • Patients who underwent cardiac testing had no statistically significant differences in mortality at 30 days, 90 days, or 1 year.
  • The average time to surgery was 2.76 days for patients who had stress testing; average time to surgery for patients in the control group was 1.41 days.
  • Average length of hospital stay for patients who underwent stress testing was 10.8 days, compared to an average length of stay of 8.5 days for the control group.

Additional steps could reduce need for testing
“If the anesthesiologist took additional measures to protect the patient from tachycardia, hypotension, and anemia during hip fracture surgery,” Dr. Sems explained, “we could further reduce the number of preoperative cardiac stress tests that we do. These are elderly patients with hip fractures; let’s treat them as the medically ill patients they are. Don’t stress them. Helping them through surgery makes the information from the stress tests even less necessary.”

The research team for “Cardiac stress testing has limited value prior to hip fracture surgery,” also included Pamela K. Holte, CNP; Traci L. Jurrens, MD; and Erik C. Summers, MD.

Annie Hayashi is the senior science writer for AAOS Now. She can be reached at hayashi@aaos.org