Does preoperative dipyridamole-thallium scanning reduce 90-day cardiac complications and mortality in patients with femoral neck fractures undergoing hemiarthroplasty?

Abstract Background: This study aimed to evaluate the effect of dipyridamole-thallium scanning on 90-day cardiac complications and mortality in patients with femoral neck fracture treated with hemiarthroplasty. Methods : Between 2008 and 2015, 844 consecutive patients undergoing cemented or cementless hemiarthroplasty were identified from the database of a single level-one medical center. One-hundred and thirteen patients (13.4%) underwent the dipyridamole-thallium scan test prior to surgery, and 731 patients (86.6%) did not. Patient characteristics, comorbidities, surgical variables, and duration to surgery were recorded. Multivariate logistic regression was performed, and a propensity-score-matched cohort was identified in order to determine whether dipyridamole-thallium scanning was associated with 90-day cardiac complications and mortality. Results: The incidence of 90-day cardiac complications was 19.47% in the thallium scan group and 11.58% in the non-thallium scan group ( p = 0.343) among 452 patients after propensity score-matching. The 90-day mortality rate was similar in the two groups (0.88% vs. 1.18%, p = 0.795). In the propensity score-matched patients, utilization of the dipyridamole-thallium scan was not associated with cardiac complications (matched cohort, adjusted odds ratio [OR] = 1.32; 95% confidence interval [CI] 0.75 to 2.33) or mortality (adjusted OR = 0.75; 95% CI 0.08 to 6.71) within 90 days. Risk factors for cardiac complications were an American Society of Anesthesiologists grade 3 (OR 3.19, 95% CI 1.44 to 7.08) and pre-existing cardiac comorbidities (OR 5.56, 95% CI 3.35 to 9.25). Discussion : Preoperative dipyridamole-thallium scanning was not associated with reductions in 90-day cardiac complications and mortality in patients with femoral neck fracture undergoing hemiarthroplasty. The necessity for dipyridamole-thallium scanning should be re-evaluated in elderly patients with femoral neck fractures, given that this increases the duration to surgery.