Preoperative left ventricular ejection fraction and risk for postoperative major adverse cardiovascular events in elderly patients with hip fracture / 中华创伤骨科杂志

ABSTRACT

Objective:To investigate the relationship between preoperative left ventricular ejection fraction (LVEF) and the risk for postoperative major adverse cardiovascular events (MACE) in elderly patients with hip fracture.Methods:A retrospective study was conducted to analyze the data of 403 elderly patients with hip fracture who had undergone surgical treatment at Department of Orthopedics, Beijing Anzhen Hospital from January 2015 to January 2021. Gender: 118 males and 285 females; age: 80 (74, 85) years; fracture type: 228 femoral neck fractures and 175 intertrochanteric (including subtrochanteric) fractures. Cardiovascular disease was complicated in 161 patients before surgery. The incidence of MACE within 30 days after surgery was statistically analyzed. The patients were divided into 2 groups according to whether MACE occurred 30 days after surgery: an MACE group and a non-MACE group. The baseline data, LVEF, preoperative cardiovascular complications, American Society of Anesthesiologists(ASA) grading and other indicators were compared between the 2 groups. Based on patient sample analysis, the receiver operating characteristic curve (ROC) was plotted to determine the optimal cutoff value of preoperative LVEF, according to which the relationship was analyzed between preoperative LVEF and the risk for postoperative MACE.Results:The overall incidence of postoperative MACE was 12.4% (50/403). There were statistically significant differences between the MACE group and the non-MACE group in preoperative LVEF[60.0% (56.0%, 63.0%) versus 62.0% (60.0%, 65.0%)], preoperative cardiovascular complications[74.0% (37/50) versus 35.1% (124/353)] and ASA grade ≥3[90.0% (45/50) versus 74.8% (264/353)]. ROC analysis showed that LVEF=60% was the optimal threshold for prediction of postoperative MACE (area under curve=0.680, sensitivity 48.0%, and specificity 83.0%). Multivariate logistic regression analysis showed that LVEF<60% and preoperative cardiovascular disease were risk factors for postoperative MACE. Subgroup analysis showed that the incidence of MACE in patients with LVEF<60% was significantly higher than that in patients with LVEF≥60% regardless of preoperative cardiovascular disease ( P<0.05). Conclusion:Preoperative LVEF<60% is a risk factor for postoperative MACE in elderly patients with hip fracture.