Korunmuþ ejeksiyon fraksiyonu ile kalp yetersizlikli ve sýnýrda ejeksiyon fraksiyonu ile kalp yetersizlikli yaþlý hastalarda kalça kýrýðý cerrahisi sonrasý perioperatif sonuçlar

AMAÇ: Korunmuþ ejeksiyon fraksiyonu (KEF-KY) ile kalp yetersizliðinin (KY) ve sýnýrda ejeksiyon fraksiyonu (SEF-KY) ile KY’nin kalça kýrýðý cerrahisini takiben perioperatif kardiyak ve kardiyak olmayan sonuçlar üzerindeki etkisini incelemek.
GEREÇ VE YÖNTEM: Kalça kýrýðý ameliyatý geçiren yaþlý hastalarýn (≥65 yaþ) verileri geriye dönük olarak incelendi. Sol ventrikül ejeksiyon fraksiyonu (SVEF) <%40 olan hastalar çalýþmaya dahil edilmedi. Ameliyat öncesi KEF-KY (SVEF ≥%50) ve SEF-KY (SVEF %40–49) tanýmý, hastalarýn ameliyat öncesi týbbi kayýtlarýnda KY’nin klinik dokümantasyonuna dayanmaktadýr. Çalýþmanýn birincil sonuçlarý perioperatif olumsuz olaylar ve mortaliteydi. Ýlgilenilen ikincil sonuç hastanede kalýþ süresiydi.
BULGULAR: Toplam 328 hasta (ort. yaþ 79.2±8.7 yýl ve %57.3 kadýn) çalýþmaya dahil edildi. Çalýþma popülasyonunun 250’sinde (%76.2) KY yoktu, 50’sinde (%15.2) KEF-KY ve 28’inde (% 8.6) SEF-KY vardý. Perioperatif kardiyovasküler ve kardiyovasküler olmayan komplikasyonlarýn sýklýðý %7.0 ile benzerdi. Ortalama hastanede kalýþ süresi 8.1±5.8 gündü ve hastane içi mortalite oraný %4.6 idi. KEF-KY ve SEF-KY hastalarýnýn kalýþ süresi daha uzundu ve KY olmayan hastalara göre perioperatif komplikasyon ve ölüm yaþama olasýlýðý daha yüksekti. Çok deðiþkenli analizler, KEF-KY ve SEF-KY varlýðýnýn her ikisinin de artmýþ perioperatif komplikasyonlar ve mortalite ile iliþkili olduðunu göstermiþtir.
TARTIÞMA: Çalýþmamýz, KEF-KY ve SEF-KY varlýðýnýn kalça kýrýðý ameliyatý geçiren yaþlý hastalarda perioperatif olumsuz olaylarý ve mortaliteyi tahmin edebileceðini göstermiþtir.

Perioperative outcomes following a hip fracture surgery in elderly patients with heart failure with preserved ejection fraction and heart failure with a mid-range ejection fraction

BACKGROUND: To examine the influence of heart failure (HF) with preserved ejection fraction (HFPEF) and HF with mid-range ejection fraction (HFmrEF) on perioperative cardiac and noncardiac outcomes following hip fracture surgery.
METHODS: Data of elderly patients (≥ 65 years) who underwent hip fracture surgery were retrospectively analyzed in this study. Patients with a left ventricular ejection fraction (LVEF) <40% were not included in this study. The definition of preoperative HFPEF (LVEF ≥50%) and HFmrEF (LVEF 40%–49%) was based on clinical documentation of HF in patients’ medical records before surgery. The primary outcomes of this study were perioperative adverse events and mortality. The secondary outcome of interest was the length of stay in the hospital.
RESULTS: A total of 328 patients (mean age 79.2±8.7 years, and 57.3% female) were enrolled. Of the study population, 250 (76.2%) patients had no HF, 50 (15.2%) patients had HFPEF, and 28 (8.6%) patients had HFmrEF before surgery. The frequency of perioperative cardiovascular and non-cardiovascular complications was similar to a rate of 7.0%. The mean length of hospital stay was 8.1±5.8 days, and the in-hospital mortality rate was 4.6%. Patients with HFPEF and HFmrEF had a longer length of stay and were more likely to experience perioperative complications and death than the patients without HF. Multivariate analyses showed that the presence of HFPEF and HFmrEF were both associated with increased rates of perioperative complications and mortality.
CONCLUSION: Our findings suggest that the presence of HFPEF and HFmrEF may predict perioperative adverse events and mortality in elderly patients undergoing hip fracture surgery.