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Cid-Serra, Ximena, Royse, Alistair, Bowyer, Andrea, et al. | Trials (2025) 26(1):333 | Preoperative focused echocardiography on patients with fractured neck of femur. ECHONOF-III trial: study protocol for a multicenter randomized controlled trial

November 29, 2025

Background: Hip fractures are common in older adults and are associated with high perioperative mortality. Prompt surgical intervention within the first 48 hours of fracture reduces complications; however, the urgency of surgery often limits the opportunity for comprehensive preoperative cardiac evaluation. Preliminary evidence suggests that performing focused cardiac ultrasound (FCU) before surgery may reduce postoperative complications. This study aims to test the primary hypothesis that FCU reduces the 30-day incidence of mortality and serious postoperative complications.

Methods: This definitive multicenter pragmatic randomized controlled trial will enroll 2,000 adults with hip fractures. Participants will be randomized before surgery to either receive FCU as part of their preoperative assessment or undergo routine preoperative care without FCU. FCU is a brief, 10-minute, goal-directed echocardiographic examination performed at the patient’s bedside by physicians trained in FCU. Findings will be immediately communicated to the anesthesiologists, orthopedic surgeons, geriatricians, and other clinicians involved in patient care. The primary outcome is a 30-day composite of all-cause mortality, hospital readmission, acute kidney injury, cardiac failure, and myocardial injury after noncardiac surgery. Secondary and exploratory outcomes include hospital length of stay, time to return to the original residence, postoperative recovery, quality of life, and a health economic analysis comparing costs with clinical benefits.

Discussion: This large randomized controlled trial aims to determine whether preoperative focused cardiac ultrasound in patients with hip fractures reduces serious postoperative complications, improves recovery and quality of life, and is a cost-effective addition to routine perioperative care.

Trial Registration: ACTRN12622001546741. Registered on December 14, 2022.

Keywords: Anesthesia; Echocardiography; Ultrasound; Hip fracture; Preoperative assessment.