Accuracy of preoperative lung ultrasound score for the prediction of major adverse cardiac events in elderly patients undergoing HIP surgery under spinal anesthesia: The LUSHIP multicenter observational prospective study - 08/11/24
Doi : 10.1016/j.accpm.2024.101432
Luigi Vetrugno a, b, ⁎ 
, Enrico Boero c , Paola Berchialla d, Francesco Forfori e, Mattia Bernardinetti f, Savino Spadaro g , Gianmaria Cammarota h , Andrea Bruni i, Eugenio Garofalo i, Marco Tescione j, Cristian Deana k , Nicola Federici k, Lisa Mattuzzi l, Francesco Meroi k, Luca Flaibani l, Andrea Cortegiani m, n , Federico Longhini i , Alessandro Cavarape l, o, Daniele Guerino Biasucci p, Stefano D’Incà q, Anna Pesamosca q, Agnese Cattarossi q, Saskia Granzotti q, Loris D’Orlando r, Felice Urso c, Camilla Colombotto c, Pieter Roel Tuinman s, Edoardo De Robertis t, Sergio Livigni u, Salvatore Maurizio Maggiore v, w , Vito Marco Ranieri x, y, Elena Giovanna Bignami z
, Enrico Boero c , Paola Berchialla d, Francesco Forfori e, Mattia Bernardinetti f, Savino Spadaro g , Gianmaria Cammarota h , Andrea Bruni i, Eugenio Garofalo i, Marco Tescione j, Cristian Deana k , Nicola Federici k, Lisa Mattuzzi l, Francesco Meroi k, Luca Flaibani l, Andrea Cortegiani m, n , Federico Longhini i , Alessandro Cavarape l, o, Daniele Guerino Biasucci p, Stefano D’Incà q, Anna Pesamosca q, Agnese Cattarossi q, Saskia Granzotti q, Loris D’Orlando r, Felice Urso c, Camilla Colombotto c, Pieter Roel Tuinman s, Edoardo De Robertis t, Sergio Livigni u, Salvatore Maurizio Maggiore v, w , Vito Marco Ranieri x, y, Elena Giovanna Bignami z LUSHIP Study Group
Active Ageing interdisciplinary Teambx
Sandro Pregnolato aa, Francesco Corradi ab, Federico Dazzi ac, Sara Tempini ad, Alessandro Isirdi ae, Moro Federico af, Nicole Giovane ag, Milo Vason ah, Carlo Alberto Volta ai, Edoardo De Robertis aj, Fabio Gori ak, Rachele Simonte al, Michela Neri am, Auro Caraffa an, Giovanni Cosco ao, Eugenio Vadalà ap, Demetrio Labate aq, Nicola Polimeni ar, Marilena Napolitano as, Sebastiano Macheda at, Angela Corea au, Lucia Lentin av, Michele Divella aw, Daniele Orso ax, Clara Zaghis ay, Silvia Del Rio az, Serena Tomasino ba, Alessandro Brussa bb, Natascia D’Andrea bc, Simone Bressan bd, Valentina Bellini be, Giuseppe Neri bf, Pietro Giammanco bg, Alberto Nicolò Galvano bh, Mariachiara Ippolito bi, Fabrizio Ricci bj, Francesca Stefani bk, Lolita Fasoli bl, Nicola Fasano bm, Irene Batticci bn, Piergiorgio Bresil bo, Federica Curto bp, Lorenzo Pirazzoli bq, Carlo Frangioni br, Mattia Puppo br, Sabrina Mussetta bs, Michele Autelli bt, Giuseppe Giglio bu, Filippo Riccone bv, Erika Taddei bw
aa Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
ab Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
ac Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
ad Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
ae Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
af Department of Translational Medicine, Faculty of Medicine and Surgery, University of Ferrara
ag Department of Translational Medicine, Faculty of Medicine and Surgery, University of Ferrara
ah Department of Translational Medicine, Faculty of Medicine and Surgery, University of Ferrara
ai Department of Translational Medicine, Faculty of Medicine and Surgery, University of Ferrara
aj Department of Medicine and Surgery, Università degli Studi di Perugia, Perugia, Italy
ak Section of Anesthesia, Intensive Care and Pain Medicine, Santa Maria della Misericordia Hospital, Perugia, Italy
al Department of Medicine and Surgery, Università degli Studi di Perugia, Perugia, Italy
am Department of Medicine and Surgery, Università degli Studi di Perugia, Perugia, Italy
an University of Perugia
ao Cosenza Hospital, Italy
ap Anesthesia and Intensive Care Unit, Grande Ospedale Metropolitano, Reggio Calabria, Italy
aq Anesthesia and Intensive Care Unit, Grande Ospedale Metropolitano, Reggio Calabria, Italy
ar Anesthesia and Intensive Care Unit, Grande Ospedale Metropolitano, Reggio Calabria, Italy
as Anesthesia and Intensive Care Unit, Grande Ospedale Metropolitano, Reggio Calabria, Italy
at Anesthesia and Intensive Care Unit, Grande Ospedale Metropolitano, Reggio Calabria, Italy
au Anesthesia and Intensive Care Unit, Grande Ospedale Metropolitano, Reggio Calabria, Italy
av Anesthesia and Intensive Care Unit, Grande Ospedale Metropolitano, Reggio Calabria, Italy
aw Department of Anesthesia and Intensive Care, Health Integrated Agency of Friuli Centrale, Udine, Italy
ax Department of Anesthesia and Intensive Care, Health Integrated Agency of Friuli Centrale, Udine, Italy
ay Department of Medicine, University of Udine, Anesthesia and Intensive Care Clinic, Udine, Italy
az Department of Medicine, University of Udine, Anesthesia and Intensive Care Clinic, Udine, Italy
ba Department of Anesthesia and Intensive Care, Health Integrated Agency of Friuli Centrale, Udine, Italy
bb Department of Anesthesia and Intensive Care, Health Integrated Agency of Friuli Centrale, Udine, Italy
bc Department of Anesthesia and Intensive Care, Health Integrated Agency of Friuli Centrale, Udine, Italy
bd Department of Medicine, University of Udine, Anesthesia and Intensive Care Clinic, Udine, Italy
be Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy
bf Department of Anesthesia Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, Italy
bg Department of Anesthesia Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, Italy
bh Department of Anesthesia Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, Italy
bi Department of Anesthesia Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, Italy
bj Department of Anesthesiology, Critical Care Medicine and Emergency, SS. Annunziata Hospital, Chieti, Italy
bk Department of Anesthesia and Intensive Care, Health Integrated Agency of Friuli Centrale, Udine, Italy
bl Paediatric Department, University of Udine, Italy
bm Anesthesia and Intensive Care Unit, Health Integrated Agency of Friuli Centrale, Tolmezzo Hospital, Tolmezzo, Italy
bn Anesthesia and Intensive Care Unit, Health Integrated Agency of Friuli Centrale, Tolmezzo Hospital, Tolmezzo, Italy
bo Anesthesia and Intensive Care Unit, Health Integrated Agency of Friuli Centrale, Tolmezzo Hospital, Tolmezzo, Italy
bp Anesthesia and Intensive Care Unit, San Giovanni Bosco Hospital, Turin, Italy
bq Anesthesia and Intensive Care Unit, San Giovanni Bosco Hospital, Turin, Italy
br Anesthesia and Intensive Care Unit, San Giovanni Bosco Hospital, Turin, Italy
bs Anesthesia and Intensive Care Unit, San Giovanni Bosco Hospital, Turin, Italy
bt Anesthesia and Intensive Care Unit, San Giovanni Bosco Hospital, Turin, Italy
bu Othopedics Department, Health Integrated Agency of Friuli Centrale, Udine, Italy
bv Department of Medicine, Unit of Anesthesia Intensive Care Pain Management, Università Campus Bio-Medico Di Roma, Rome, Italy
bw Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
bx University of Udine, Udine, Italy
a Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy
b Department of Anesthesiology, Critical Care Medicine and Emergency, SS. Annunziata Hospital, Chieti, Italy
c Anesthesia and Intensive Care Unit, San Giovanni Bosco Hospital, Turin, Italy
d Center of Biostatistics, Epidemiology and Public Health, Department of Clinical and Biological Sciences, University of Torino, Turin, Italy
e Department Anesthesia and Intensive Care, University of Pisa, Pisa, Italy
f Department of Medicine, Unit of Anesthesia Intensive Care Pain Management, Università Campus Bio-Medico Di Roma, Rome, Italy
g Department of Translational Medicine, Anesthesia and Intensive Care Unit, University of Ferrara, Ferrara, Italy
h Anesthesia and Intensive Care, Department of Translational Medicine, Eastern Piedmont University, Novara, Italy
i Anesthesia and Intensive Care Unit, Department of Medical and Surgical Sciences, ‘Magna Graecia’ University of Catanzaro, Italy
j Anesthesia and Intensive Care Unit, Grande Ospedale Metropolitano, Reggio Calabria, Italy
k Department of Anesthesia and Intensive Care, Health Integrated Agency of Friuli Centrale, Udine, Italy
l Department of Medicine, University of Udine, Anesthesia and Intensive Care Clinic, Udine, Italy
m Department of Surgical Oncological and Oral Science, University of Palermo, Palermo, Italy
n Department of Anesthesia Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, Italy
o Internal Medicine, Udine University Hospital, Udine, Italy
p Department of Clinical Science and Translational Medicine, ‘Tor Vergata’ University of Rome, Rome, Italy
q Anesthesia and Intensive Care Unit, Health Integrated Agency of Friuli Centrale, Tolmezzo Hospital, Tolmezzo, Italy
r Anesthesia and Intensive Care Unit, Health Integrated Agency of Friuli Centrale, Tolmezzo Hospital, Tolmezzo, Italy
s Department of Intensive Care Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
t Anesthesia and Intensive Care, Department of Medicine and Surgery, Università degli Studi di Perugia, Perugia, Italy
u Anesthesia and Intensive Care Unit, San Giovanni Bosco Hospital, Turin, Italy
v Department of Innovative Technologies in Medicine and Dentistry, Gabriele d’Annunzio University of Chieti-Pescara, Chieti, Italy
w Critical Care Medicine and Emergency Department of Anesthesiology, SS. Annunziata Hospital, Chieti, Italy
x Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum-University of Bologna, Bologna, Italy
y Anesthesiology and General Intensive Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di S. Orsola, Bologna, Italy
z Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy
⁎Corresponding author.
Graphical abstract |
Highlights |
• | Elderly patients undergoing urgent hip fracture surgery are prone to postoperative major acute cardiovascular events (MACE). |
• | Classical cardiac risk scores have moderate prediction ability. |
• | Preoperative lung ultrasound score (LUS score) was higher in patients with than without MACE. |
• | LUS has high predictive ability (AUC 0.78) for MACE. |
• | LUS could improve patients’ risk stratification both alone or in addition to the classical risk scoring systems. |
Abstract |
Background and objective |
We hypothesize that lung ultrasound scores (LUS) can help stratify the cardiac risk of elderly patients undergoing orthopedic surgery for hip fracture, adding value to the Revised Cardiac Risk Index (RCRI), the American Society of Anesthesiologists Physical Status (ASA-PS) and the National Surgical Quality Improvement Program Myocardial infarction and Cardiac arrest (NSQIP-MICA).
Methods |
Prospective, observational multicenter study of 11 Italian hospitals on patients aged >65 years with hip fractures needing urgent surgery. Subjects with major adverse cardiovascular events (MACE) in the previous 6 months or with ongoing acute heart failure were excluded. Trained anesthesiologists obtained preoperative LUS scores during preoperative evaluation. ROC curve analysis and comparison were used to evaluate test accuracy.
Results |
A total of 877 patients were enrolled in the study period. 108 MACE events occurred in 98 patients, with an overall incidence of 11.2%. LUS score was higher in complicated than non-complicated patients, 11.6 ± 6.64 vs. 4.97 ± 4.90 (p < 0.001). Preoperative LUS score ≥8 showed both better AUC (0.78) and accuracy (0.76) in predicting MACE than the RCRI scores (p < 0.001), MICA scores (p = 0.001) and ASA classes (p < 0.001). LUS sensitivity was 0.71, specificity was 0.76, negative predictive value was 0.95. LUS score ≥8 showed an OR for MACE of 5.81[95% CI 3.55–9.69] at multivariate analysis. 91 patients (10.4%) experienced postoperative pneumonia showing a preoperative LUS score higher in the non-pneumonia group, p < 0.001.
Conclusions |
The preoperative LUS score, with its high negative predictive value, could improve patients’ risk stratification when used alone or add further value to the RCRI score.
Registration |
Registered at clinicaltrials.gov as NCT04074876.
Le texte complet de cet article est disponible en PDF.Keywords : Lung ultrasound, Hip fracture, Post-operative pneumonia, Major adverse cardiac events, Preoperative evaluation
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© 2024
The Author(s). Publié par Elsevier Masson SAS. Tous droits réservés.
Vol 43 - N° 6
Article 101432- décembre 2024 Retour au numéro
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