In reply to the letter to the editor by Paul et al

Oberweis, Brandon S.; Berger, Jeffrey S.

doi:10.1016/j.ahj.2013.03.010

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“…18 Post-operative myocardial necrosis and MI were recorded. Myocardial necrosis was defined by an elevation in troponin level greater than the 99 th percentile upper reference limit of the assay.…”

Section: Methodsmentioning

confidence: 99%

Relation of Perioperative Elevation of Troponin to Long-Term Mortality After Orthopedic Surgery

Oberweis¹,

Smilowitz²,

Nukala³

et al. 2015

The American Journal of Cardiology

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Background Myocardial necrosis in the perioperative period of non-cardiac surgery is associated with short-term mortality, but the effect on long-term outcomes has not been characterized. We investigated the association between perioperative troponin elevation and long-term mortality in a retrospective study of subjects undergoing major orthopedic surgery. Methods We performed a long-term follow-up study of consecutive subjects undergoing hip, knee, and spine surgery between November 1, 2008 and December 31, 2009. Patient demographics and comorbidities were ascertained using a hospital administrative dataset. Perioperative myocardial necrosis and ICD-9 coded myocardial infarction (MI) were recorded. Long-term survival was assessed using the Social Security Death Index (SSDI) database. Logistic regression models were used to identify independent predictors of long-term mortality. Results A total of 3,075 subjects underwent orthopedic surgery. Mean age was 60.7 years and a majority of subjects (59%) were female. Post-operative troponin was measured in 1060 (34.5%) subjects. Myocardial necrosis occurred in 179 (5.3%%) subjects and MI was coded in 20 (0.7%). Over 9,096 patient-years of follow up, 111 (3.6%) deaths occurred. Long-term mortality was 16.8% among subjects with myocardial necrosis, 5.8% with a troponin in the normal range, and 1.5% when a perioperative troponin was not measured. Perioperative troponin elevation (HR 2.33, CI 1.33 – 4.10) and coded post-operative MI (adjusted HR 3.51, CI 1.44 – 8.53) were significantly associated with long-term mortality after multivariable adjustment. Conclusions Post-operative myocardial necrosis is common following orthopedic surgery. Myocardial necrosis is independently associated with long-term mortality and may be used to identify subjects at higher risk for cardiovascular events who may benefit from aggressive management of cardiovascular risk factors.

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Section: Methodsmentioning

confidence: 99%