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Preoperative cardiac risk factors associated with in-hospital mortality in elderly patients without heart failure undergoing hip fracture surgery: a single-centre study
  1. Vedat Çiçek1,
  2. Tufan Cinar1,
  3. Mert Ilker Hayiroglu2,
  4. Şahhan Kılıç1,
  5. Nürgül Keser1,
  6. Mehmet Uzun1,
  7. Ahmet Lütfullah Orhan1
  1. 1 Health Sciences University, Sultan 2, Abdülhamid Han Training and Research Hospital, Department of Cardiology, Uskudar, Turkey
  2. 2 Health Sciences University, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
  1. Correspondence to Tufan Çinar, Health Science University, 2. Sultan Abdülhamid Han Training and Research Hospital, Department of Cardiology, Tibbiye Street, Uskudar, Istanbul, Turkey; drtufancinar{at}


Introduction In the present study, our aim was to ascertain the preoperative cardiac risk factors related to the in-hospital mortality in the elderly patients (aged over 65 years) who required preoperative cardiology consultation for hip fracture surgery.

Material and Methods The present study was a retrospective, single-centre study, which enrolled consecutive elderly patients without heart failure scheduled for hip fracture surgery in our institution. In all patients, an anesthesiologist performed a detailed preoperative evaluation and decided the need for the cardiac consultation. Patients underwent preoperative cardiac evaluation by a trained cardiologist using the algorithms proposed in the recent preoperative guidelines. The in-hospital mortality was the main outcome of the study.

Results In total, 277 elderly patients undergoing hip fracture surgery were enrolled in this analysis. The overall in-hospital mortality rate was 12.1% (n=30 cases). In a multivariate analysis, we found that insulin dependency, cancer, urea, presence of atrial fibrillation (AF) (OR: 3.906; 95% CI 1.470 to 10.381; p=0.006) and pulmonary artery systolic pressure (PASP) (OR: 1.057; 95% CI 1.016 to 1.100; p=0.006) were the predictors of in-hospital mortality. The receiver operating characteristic curve analysis revealed that the optimal value of PASP in predicting the in-hospital mortality was 35 mm Hg (area under the curve=0.71; 95% CI 0.60 to 0.81, p<0.001) with sensitivity of 87.7% and specificity of 59.5%.

Conclusion The present research found that the preoperative cardiac risk factors, namely AF and PASP, might be associated with increased in-hospital mortality in elderly patients without heart failure undergoing hip fracture surgery.

  • Orthopaedic & trauma surgery
  • hip
  • internal medicine
  • cardiology
  • health services administration & management
  • risk management

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  • Contributors VÇ, TC and MIH planned the study. MIH, TC, VÇ and ŞK collected the data. MIH analysed the data. VÇ and TC performed the literature search and wrote the paper. NK, MU and ALO made the critical revision of the paper. All authors have contributed significantly to the manuscript to be published.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The Institutional Review Board approved the design of the present study (ethic code number: 2020/KK/96). Our study was conducted in accordance with the principles of the Declaration of Helsinki 1975, as revised in 2008.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

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