Echocardiography Does Not Delay Surgery in Elderly Patient with Hip Fracture: Pulmonary Hypertension and Decreased Left Ventricular Ejection Fraction Are Associated with in Hospital Mortality

Cardiovascular complications are the main cause of early mortality in elderly patients after hip fracture surgery. Echocardiography, although suggested by guidelines to improve risk stratification, is frequently omitted for the risk to delay surgery. Aim of the study was to evaluate whether preoperative echocardiographic in patients with hip fracture effectively delays surgery and which echocardiographic abnormalities are associated with in-hospital mortality. The study included hip fracture patients aged > 70 years admitted in the period January 1, 2019, to December 31, 2024, to the Hip fracture Unit of a teaching tertiary hospital. Echocardiography was indicated according to clinical criteria (detection of heart murmur, pathological electrocardiographic changes, known heart disease and the presence of > 2 coronary risk factors). In the study entered 2272 patients, 1593 had indication for preoperative echocardiography that was performed in 1502. Mean age was significantly higher in ECHO than in NO-ECHO group (85.4 ± 8 vs. 80.5 ± 11 years, p < 0.0001). ECHO group patients had more frequently at least two comorbidities. In-hospital mortality was 7.3% in ECHO patients compared to 2.3% in NO-ECHO patients. At multivariate analysis showed decreased left ventricular ejection fraction and pulmonary hypertension other than age, anemia, reduced functional capacity expressed as lost BADL and cancer were independent predictors of in-hospital mortality. Echocardiography identifies a population at a high risk of in-hospital mortality, three times higher compared to the group of NO ECHO patients. A reduced left ventricular ejection fraction and an increase in pulmonary pressure are independent predictors of in hospital mortality.