P051: AORTIC STENOSIS WAS ASSOCIATED WITH INCREASED MORTALITY IN SURGICAL HIP FRACTURE PATIENTS
Eslam A Fouda, MD1; Harold E Chaves-Cardona, MD1; J. Ross Renew, MD, FASA, FASE1; Aaron C Spaulding, PhD2; Steven B Porter, MD, FASA1; 1Department of Anesthesiology and Perioperative Medicine, Mayo Clinic; 2Department of Health Care Delivery Research, Mayo Clinic
Introduction: In the United States, hip fracture rates constitute 72% of fracture-related health care expenses. The incidence of hip fracture increases with age, doubling every 10 years after the age of 50. Aortic valve stenosis (AS) shares some of the same epidemiological patterns as hip fractures. With a prevalence of 2% and 12.4 % in patients over the age of 65 and 75, respectively, the presence of AS in elderly patients with hip fracture is not uncommon. This study investigates the association between aortic stenosis and postoperative mortality and serious complications in surgical hip fracture patients.
Methods: After institutional review board (IRB) approval, a retrospective chart review was performed of patients with AS who underwent hip fracture surgical repair between January 2011 and December 2019 within one health system. A control group of hip fracture patients without AS was identified and matched based on body mass index, age, sex, date of surgery, and Charlson comorbidity index. The primary outcome of interest was 90-day mortality; secondary endpoints were identified through postoperative clinical notes and included: length of hospital stay (LOS); 30-day incidence of pneumonia, myocardial infarction (MI), stroke, pulmonary embolism (PE), deep vein thrombosis (DVT), and acute kidney injury (AKI). We also collected the need for intensive care unit (ICU) admission, the usage and amount of intraoperative intravenous (IV) fluids and vasoactive drugs, and placement of arterial lines (AL).
Results: We were able to match 146 patients identified with AS to 146 patients without AS. In the AS group, there was an increased odds of 90-day mortality (OR: 2.64, 95% CI: 1.32, 5.28, p=0.005). Similarly, the AS group had an increased odds of ICU admission (OR 3.00, 95% CI: 1.36, 6.68, p=0.004). We did not detect differences in 30-day postoperative complications (pneumonia, MI, stroke, PE, DVT, or acute kidney injury) (Table1). The AL placement was higher in AS than non-AS patients (p<0.001). Intraoperatively, there was a significant increase in the mean amount of Ringer’s lactate (p=0.047) and the mean dose of phenylephrine in the AS group (p=0.013) (Table2).
Conclusion: In this matched cohort study, our results demonstrate that AS was independently associated with increased postoperative 90-day mortality and post-operative ICU admission. The amount of Ringer’s lactate, the dose of phenylephrine, and the rate of AL placement were all significantly higher in AS patients. Importantly, we detected no intra-operative critical events or mortality, or significant difference in in-hospital deaths between the two groups. This study represents the largest matched cohort in recent literature in the United States evaluating outcomes between AS and non-AS patients undergoing hip fracture surgery. Thus, even in the modern era of healthcare, hip fracture patients with AS require a high degree of clinical vigilance throughout their perioperative period.