Correlation between Hip Fracture Surgery and Increased Risk for Heart Failure in Older Patients – A Literature Review
Authors: Adetunji Elijah Oluwasegun Ayoigbala , Balogun Toluwani 
Published: August 2023

Background: The present study evaluates the correlation between Hip Fracture Surgery and Increased Risk for Heart Failure in Older Patients. Heart failure leads to other complications in patients with hip fractures as well as post-operative ICU care, longer hospital admissions, high financial and health costs, and increased risk of hospital-acquired illnesses such as pneumonia, bedsores, postural deconditioning, etc. The relationship between the length of hip surgery and heart failure is significant. The underlying factors that increase the risk of heart failure after surgery include longer stress of surgery that increases the load on the heart. Hip replacement surgery has direct effects on the heart leading to various heart diseases and the worst-case scenario results in a heart attack. When accompanied by a previous history of heart attacks, it could make the percentage of heart failure in hip replacement patients, devastatingly high. Complete evaluation of the patient and planning accordingly helps the patient to decrease the risks of surgery and attain fast and better recovery.

Materials and Methods: The population study includes patients who had just undergone hip fracture surgery and later developed heart failure. We analyzed English-language literature published on PUBMED and MEDLINE, MEDSCAPE issued from 2010 to 2023, using keywords heart failure, CAD, Echo, ECG, hip fracture, stress test, anemia, etc. The risk assessment of patients with CAD preoperative was performed using the American College of Cardiology/American Heart Association algorithm, which involved electrocardiogram, echocardiogram, and pharmacological (dobutamine) stress test. As a result of our patient’s mobility impairment the pharmacological test was the most relevant.

Results: The study found that the cumulative rate of postoperative heart failure was 21.3% (95% confidence interval [CI], 18.8% - 23.7%). Rates of postoperative heart failure were significantly higher among those with preoperative heart failure (hazard ratio, 3.0; 95% CI, 2.3% - 3.9%; P < .001). The risk for inpatient mortality was much higher in those who developed early postoperative heart failure (odds ratio, 4.7; 95% CI, 2.4% - 9.0%; P < .001).

The investigators looked at a number of possible predictors of heart failure and compared them with events that occurred after surgery. The highest number of postoperative cardiac events was for patients older than 75 years (229 events), followed by those with hypertension (157 events), angina (108 events), atrial fibrillation (94 events), a previous heart attack (86 events), and cerebrovascular disease (85 events). Patients older than 85 years had 134 events.

The medications given before surgery for cardiac conditions that led to the highest number of incidents were aspirin (89 events), loop diuretics (84 events), angiotensin-converting-enzyme inhibitors or angiotensin-receptor blockers (69 events), calcium channel blockers (54 events), and digoxin (54 events)e) stress test.

Conclusion: In conclusion, intraoperative and postoperative heart failure are common and serious complications in patients undergoing surgery for heart failure. The occurrence of heart failure in patients is due to a combination of several risk factors including age > 70 years, prolonged duration of surgery > 120 min, anemia, and comorbidities