PREOPERATIVE TWO DIMENSIONAL ECHOCARDIOGRAPHY IN PATIENTS WITH LOWER LIMB FRACTURES; ITS RELATIONSHIP WITH TIME OF SURGERY, POSTOPERATIVE AMBULATION AND HOSPITAL STAY

Objective: To determine the effect of two dimensional echocardiography on time of surgery, post-operative ambulation and hospital stay among patients with lower limb fractures. Study Design: Descriptive cross sectional study. Place and Duration of Study: Combined Military Hospital Rawalpindi, from Sep 2015 to Dec 2015. Patients and Methods: A total of 123 patients were included in study based on non-probability convenient sampling who presented with lower limb fractures. The patients were divided into two groups, group A included those who underwent only electrocardiogram (ECG) for assessment and group B included those patients who were further assessed by echocardiography. Results: There was significant delay in group B patients from time of admission to surgery (p=0.0001) as well as post-operative ambulation (p=0.0001) and mean hospital stay was also longer (p=0.0005). However the postoperative complications were similar in two groups. Conclusion: Pre-operative cardiac evaluation by echocardiography is associated with delay in surgery and increases overall hospital stay. The implementation of the American College of Cardiology/American Heart Association guidelines may prevent unnecessary cardiac consultations which can minimize use of preoperative resources, delay in time of surgery and early post-operative recovery. Keywords: American College of Cardiology/ American Heart Association guidelines, Delay in surgery, Echocardiography, Fracture fixation, Lower limb fractures.