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

Luigi Vetrugno; Enrico Boero; Paola Berchialla; Francesco Forfori; Mattia Bernardinetti; Savino Spadaro; Gianmaria Cammarota; Andrea Bruni; Eugenio Garofalo; Marco Tescione; Cristian Deana; Nicola Federici; Lisa Mattuzzi; Francesco Meroi; Luca Flaibani; Andrea Cortegiani; Federico Longhini; Alessandro Cavarape; Daniele Guerino Biasucci; Stefano D'Incà; Anna Pesamosca; Agnese Cattarossi; Saskia Granzotti; Loris D'Orlando; Felice Urso; Camilla Colombotto; Pieter Roel Tuinman; Edoardo de Robertis; Sergio Livigni; Salvatore Maurizio Maggiore; Vito Marco Ranieri; Elena Giovanna Bignami; Sandro Pregnolato; Francesco Corradi; Federico Dazzi; Sara Tempini; Alessandro Isirdi; Moro Federico; Nicole Giovane; Milo Vason; Carlo Alberto Volta; Edoardo De Robertis; Fabio Gori; Rachele Simonte; Michela Neri; Auro Caraffa; Giovanni Cosco; Eugenio Vadalà; Demetrio Labate; Nicola Polimeni; Marilena Napolitano; Sebastiano Macheda; Angela Corea; Lucia Lentin; Michele Divella; Daniele Orso; Clara Zaghis; Silvia Del Rio; Serena Tomasino; Alessandro Brussa; Natascia D'Andrea; Simone Bressan; Valentina Bellini; Giuseppe Neri; Pietro Giammanco; Alberto Nicolò Galvano; Mariachiara Ippolito; Fabrizio Ricci; Francesca Stefani; LUSHIP Study Group; Active Ageing interdisciplinary Team

doi:10.1016/j.accpm.2024.101432

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

Luigi Vetrugno^*
, Enrico Boero
, Paola Berchialla
, Francesco Forfori
, Mattia Bernardinetti
, Savino Spadaro
, Gianmaria Cammarota
, Andrea Bruni
, Eugenio Garofalo
, Marco Tescione
, Cristian Deana
, Nicola Federici
, Lisa Mattuzzi
, Francesco Meroi
, Luca Flaibani
, Andrea Cortegiani
, Federico Longhini
, Alessandro Cavarape
, Daniele Guerino Biasucci
, Stefano D'Incà

Anna Pesamosca, Agnese Cattarossi, Saskia Granzotti, Loris D'Orlando, Felice Urso, Camilla Colombotto, Pieter Roel Tuinman, Edoardo de Robertis, Sergio Livigni, Salvatore Maurizio Maggiore, Vito Marco Ranieri, Elena Giovanna Bignami, Sandro Pregnolato, Francesco Corradi, Federico Dazzi, Sara Tempini, Alessandro Isirdi, Moro Federico, Nicole Giovane, Milo Vason, Carlo Alberto Volta, Edoardo De Robertis, Fabio Gori, Rachele Simonte, Michela Neri, Auro Caraffa, Giovanni Cosco, Eugenio Vadalà, Demetrio Labate, Nicola Polimeni, Marilena Napolitano, Sebastiano Macheda, Angela Corea, Lucia Lentin, Michele Divella, Daniele Orso, Clara Zaghis, Silvia Del Rio, Serena Tomasino, Alessandro Brussa, Natascia D'Andrea, Simone Bressan, Valentina Bellini, Giuseppe Neri, Pietro Giammanco, Alberto Nicolò Galvano, Mariachiara Ippolito, Fabrizio Ricci, Francesca Stefani, LUSHIP Study Group, Active Ageing interdisciplinary Team

^*Corresponding author for this work

Gabriele d'Annunzio University
SS. Annunziata Hospital
Azienda Sanitaria Ospedaliera Molinette San Giovanni Battista Di Torino
University of Turin
University of Pisa
Universita Campus Bio-Medico di Roma
University of Ferrara
University of Eastern Piedmont
Magna Græcia University
Grande Ospedale Metropolitano
Health Integrated Agency of Friuli Centrale
University of Udine
University of Palermo
Azienda Ospedaliera Universitaria Policlinico Paolo Giaccone
University of Rome Tor Vergata
Tolmezzo Hospital
Amsterdam UMC - University of Amsterdam
University of Perugia
University of Bologna
Interventional Pulmonology Unit, Policlinico S. Orsola
University of Parma
University of Pavia
University Hospital of Perugia
Cosenza Hospital

Research output: Contribution to journal › Article › Academic › peer-review

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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.

Original language	English
Article number	101432
Journal	Anaesthesia, critical care and pain medicine
Volume	43
Issue number	6
DOIs	https://doi.org/10.1016/j.accpm.2024.101432
Publication status	Published - 1 Dec 2024

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

Hip fracture
Lung ultrasound
Major adverse cardiac events
Post-operative pneumonia
Preoperative evaluation

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Vetrugno, L., Boero, E., Berchialla, P., Forfori, F., Bernardinetti, M., Spadaro, S., Cammarota, G., Bruni, A., Garofalo, E., Tescione, M., Deana, C., Federici, N., Mattuzzi, L., Meroi, F., Flaibani, L., Cortegiani, A., Longhini, F., Cavarape, A., Biasucci, D. G., ... Active Ageing interdisciplinary Team (2024). 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. Anaesthesia, critical care and pain medicine, 43(6), Article 101432. https://doi.org/10.1016/j.accpm.2024.101432

@article{9e5fae50f60c433dae00c35cd78b03a2,

title = "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",

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{\textquoteright} risk stratification when used alone or add further value to the RCRI score. Registration: Registered at clinicaltrials.gov as NCT04074876.",

keywords = "Hip fracture, Lung ultrasound, Major adverse cardiac events, Post-operative pneumonia, Preoperative evaluation",

author = "Luigi Vetrugno and Enrico Boero and Paola Berchialla and Francesco Forfori and Mattia Bernardinetti and Savino Spadaro and Gianmaria Cammarota and Andrea Bruni and Eugenio Garofalo and Marco Tescione and Cristian Deana and Nicola Federici and Lisa Mattuzzi and Francesco Meroi and Luca Flaibani and Andrea Cortegiani and Federico Longhini and Alessandro Cavarape and Biasucci, \{Daniele Guerino\} and Stefano D'Inc{\`a} and Anna Pesamosca and Agnese Cattarossi and Saskia Granzotti and Loris D'Orlando and Felice Urso and Camilla Colombotto and Tuinman, \{Pieter Roel\} and \{de Robertis\}, Edoardo and Sergio Livigni and Maggiore, \{Salvatore Maurizio\} and Ranieri, \{Vito Marco\} and Bignami, \{Elena Giovanna\} and Sandro Pregnolato and Francesco Corradi and Federico Dazzi and Sara Tempini and Alessandro Isirdi and Moro Federico and Nicole Giovane and Milo Vason and Volta, \{Carlo Alberto\} and Robertis, \{Edoardo De\} and Fabio Gori and Rachele Simonte and Michela Neri and Auro Caraffa and Giovanni Cosco and Eugenio Vadal{\`a} and Demetrio Labate and Nicola Polimeni and Marilena Napolitano and Sebastiano Macheda and Angela Corea and Lucia Lentin and Michele Divella and Daniele Orso and Clara Zaghis and Rio, \{Silvia Del\} and Serena Tomasino and Alessandro Brussa and Natascia D'Andrea and Simone Bressan and Valentina Bellini and Giuseppe Neri and Pietro Giammanco and Galvano, \{Alberto Nicol{\`o}\} and Mariachiara Ippolito and Fabrizio Ricci and Francesca Stefani and \{LUSHIP Study Group\} and Lolita Fasoli and Nicola Fasano and Irene Batticci and Piergiorgio Bresil and Federica Curto and Lorenzo Pirazzoli and Carlo Frangioni and Mattia Puppo and Sabrina Mussetta and Michele Autelli and \{Active Ageing interdisciplinary Team\} and Giuseppe Giglio and Filippo Riccone and Erika Taddei",

note = "Publisher Copyright: {\textcopyright} 2024 The Author(s)",

year = "2024",

month = dec,

day = "1",

doi = "10.1016/j.accpm.2024.101432",

language = "English",

volume = "43",

journal = "Anaesthesia, critical care and pain medicine",

issn = "2352-5568",

publisher = "Elsevier Masson s.r.l.",

number = "6",

}

Vetrugno, L, Boero, E, Berchialla, P, Forfori, F, Bernardinetti, M, Spadaro, S, Cammarota, G, Bruni, A, Garofalo, E, Tescione, M, Deana, C, Federici, N, Mattuzzi, L, Meroi, F, Flaibani, L, Cortegiani, A, Longhini, F, Cavarape, A, Biasucci, DG, D'Incà, S, Pesamosca, A, Cattarossi, A, Granzotti, S, D'Orlando, L, Urso, F, Colombotto, C, Tuinman, PR, de Robertis, E, Livigni, S, Maggiore, SM, Ranieri, VM, Bignami, EG, Pregnolato, S, Corradi, F, Dazzi, F, Tempini, S, Isirdi, A, Federico, M, Giovane, N, Vason, M, Volta, CA, Robertis, ED, Gori, F, Simonte, R, Neri, M, Caraffa, A, Cosco, G, Vadalà, E, Labate, D, Polimeni, N, Napolitano, M, Macheda, S, Corea, A, Lentin, L, Divella, M, Orso, D, Zaghis, C, Rio, SD, Tomasino, S, Brussa, A, D'Andrea, N, Bressan, S, Bellini, V, Neri, G, Giammanco, P, Galvano, AN, Ippolito, M, Ricci, F, Stefani, F, LUSHIP Study Group & Active Ageing interdisciplinary Team 2024, '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', Anaesthesia, critical care and pain medicine, vol. 43, no. 6, 101432. https://doi.org/10.1016/j.accpm.2024.101432

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. / Vetrugno, Luigi; Boero, Enrico; Berchialla, Paola et al.
In: Anaesthesia, critical care and pain medicine, Vol. 43, No. 6, 101432, 01.12.2024.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Accuracy of preoperative lung ultrasound score for the prediction of major adverse cardiac events in elderly patients undergoing HIP surgery under spinal anesthesia

T2 - The LUSHIP multicenter observational prospective study

AU - Vetrugno, Luigi

AU - Boero, Enrico

AU - Berchialla, Paola

AU - Forfori, Francesco

AU - Bernardinetti, Mattia

AU - Spadaro, Savino

AU - Cammarota, Gianmaria

AU - Bruni, Andrea

AU - Garofalo, Eugenio

AU - Tescione, Marco

AU - Deana, Cristian

AU - Federici, Nicola

AU - Mattuzzi, Lisa

AU - Meroi, Francesco

AU - Flaibani, Luca

AU - Cortegiani, Andrea

AU - Longhini, Federico

AU - Cavarape, Alessandro

AU - Biasucci, Daniele Guerino

AU - D'Incà, Stefano

AU - Pesamosca, Anna

AU - Cattarossi, Agnese

AU - Granzotti, Saskia

AU - D'Orlando, Loris

AU - Urso, Felice

AU - Colombotto, Camilla

AU - Tuinman, Pieter Roel

AU - de Robertis, Edoardo

AU - Livigni, Sergio

AU - Maggiore, Salvatore Maurizio

AU - Ranieri, Vito Marco

AU - Bignami, Elena Giovanna

AU - Pregnolato, Sandro

AU - Corradi, Francesco

AU - Dazzi, Federico

AU - Tempini, Sara

AU - Isirdi, Alessandro

AU - Federico, Moro

AU - Giovane, Nicole

AU - Vason, Milo

AU - Volta, Carlo Alberto

AU - Robertis, Edoardo De

AU - Gori, Fabio

AU - Simonte, Rachele

AU - Neri, Michela

AU - Caraffa, Auro

AU - Cosco, Giovanni

AU - Vadalà, Eugenio

AU - Labate, Demetrio

AU - Polimeni, Nicola

AU - Napolitano, Marilena

AU - Macheda, Sebastiano

AU - Corea, Angela

AU - Lentin, Lucia

AU - Divella, Michele

AU - Orso, Daniele

AU - Zaghis, Clara

AU - Rio, Silvia Del

AU - Tomasino, Serena

AU - Brussa, Alessandro

AU - D'Andrea, Natascia

AU - Bressan, Simone

AU - Bellini, Valentina

AU - Neri, Giuseppe

AU - Giammanco, Pietro

AU - Galvano, Alberto Nicolò

AU - Ippolito, Mariachiara

AU - Ricci, Fabrizio

AU - Stefani, Francesca

AU - LUSHIP Study Group

AU - Fasoli, Lolita

AU - Fasano, Nicola

AU - Batticci, Irene

AU - Bresil, Piergiorgio

AU - Curto, Federica

AU - Pirazzoli, Lorenzo

AU - Frangioni, Carlo

AU - Puppo, Mattia

AU - Mussetta, Sabrina

AU - Autelli, Michele

AU - Active Ageing interdisciplinary Team

AU - Giglio, Giuseppe

AU - Riccone, Filippo

AU - Taddei, Erika

PY - 2024/12/1

Y1 - 2024/12/1

N2 - 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.

AB - 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.

KW - Hip fracture

KW - Lung ultrasound

KW - Major adverse cardiac events

KW - Post-operative pneumonia

KW - Preoperative evaluation

UR - https://www.scopus.com/pages/publications/85208170590

U2 - 10.1016/j.accpm.2024.101432

DO - 10.1016/j.accpm.2024.101432

M3 - Article

C2 - 39369987

SN - 2352-5568

VL - 43

JO - Anaesthesia, critical care and pain medicine

JF - Anaesthesia, critical care and pain medicine

IS - 6

M1 - 101432

ER -

Vetrugno L, Boero E, Berchialla P, Forfori F, Bernardinetti M, Spadaro S et al. 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. Anaesthesia, critical care and pain medicine. 2024 Dec 1;43(6):101432. doi: 10.1016/j.accpm.2024.101432

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

Abstract

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Keywords

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