Elevated Right Ventricular Systolic Pressure and Outcomes after Major Hip Surgery: A Case Control Study

Patients at risk of pulmonary hypertension (PH) frequently present for emergency orthopedic surgery. A right ventricular systolic pressure (RVSP) of 35 mmHg or above, calculated from a tricuspid regurgitant jet on transthoracic echocardiography (TTE) is widely considered an appropriate screening test for PH. ¹ The aim of this study was to evaluate the impact of an elevated RVSP detected on preoperative TTE on outcomes after hip replacement or fracture fixation surgery. We undertook a retrospective, single centre, case control study of 115 adult patients who had a TTE before undergoing hip surgery over a six-year period. Forty-eight patients (42%) had an elevated RVSP and 67 patients (58%) had a normal RVSP on preoperative TTE. Patients with an elevated RVSP were older and had a higher prevalence of atrial fibrillation and chronic obstructive pulmonary disease. In multivariate analysis there was no significant association between these variables and in hospital mortality. In keeping with the echocardiographic characteristics of high right-sided pressure, tricuspid regurgitation and right ventricular dilation occurred more frequently in the elevated RVSP group. Patients with an elevated RVSP were significantly more likely to die in hospital, with all in hospital deaths occurring within this group (9/48 (19%) vs 0/67 (0%), p = < 0.001). Four patients died within one week of surgery after a cardiac arrest. The remaining 5 patients died a median of 26 (IQR 24–59) days after surgery due to pneumonia and progression of comorbid disease, often complicated by delirium. This study highlights the potential association between an elevated preoperative RVSP and increased mortality after hip replacement or fracture fixation surgery.