Clinical and biochemical prediction of early fatal outcome following hip fracture in the elderly

Abstract

Hip fracture, a moderate musculoskeletal trauma, is associated with a high postoperative mortality. Most patients are elderly, with comorbid conditions and often with heart disease. The objective of this study was to find out if clinical parameters and analyses of specific muscle enzymes could predict three month postoperative mortality. A total of 302 patients above 75 years of age with hip fracture were consecutively enrolled. Baseline information on age, sex and comorbidity assessed with the American Society of Anesthesiologists (ASA) score was obtained before surgery. Creatine kinase (CK), myocardium-specific creatine kinase (CK-MB) and troponin T (TnT) were analysed from venous blood, collected the day before surgery (−1) and postoperatively, within 24 hours (0) and on days one (+1) and four (+4). The overall three month mortality was 19.5%. Multivariate analyses showed that age, male sex and comorbidity (ASA) correlated with mortality (p = 0.027, p = 0.002, p < 0.001, respectively). Surgery induced a two- to threefold increase of CK and CK-MB but without any correlation with mortality. However, high TnT levels >0.04 μg/l correlated significantly with death (days −1, +1 and +4, p = 0.003, p = 0.005 and p = 0.003, respectively). Multivariate analyses, adjusted for age, sex and ASA category, confirmed this correlation (day +4, p = 0.008). Thus, in elderly patients with comorbidities undergoing hip fracture surgery information on sex, age, ASA category and postoperative laboratory analyses on TnT provide the clinicians with useful information on patients at risk of fatal outcome.

Perioperative mortality in hip fracture patients treated with cemented and uncemented hemiprosthesis: a register study of 11,210 patients

“…We have earlier found elevated levels of plasma troponin T that correlated with the three-month fatal outcome [11]. In the same population, we showed that affection of the liver, lung and kidney functions in comorbid elderly patients also correlated with fatal outcome [22].…”

“…In addition, the surgical trauma caused release of intracellular enzymes such as troponin T and reduced oxygen tension, consistent with damage of heart cells and reduced pulmonary function [11].…”

Predictors of early mortality after hip fracture surgery

“…A previous retrospective study in a cohort of more than 1,200 HFS patients shows perioperative MI to have occurred in 13.8 % of patients within seven days of surgery, with a subsequent fourfold increase in 30-day mortality [23]; three fourths of those patients were asymptomatic. Recommendations have therefore been made for the routine use of postoperative troponin measurements, despite the absence of symptoms, as an in-hospital preventative strategy to reduce MI related mortality [23][24][25][26]. We found a moderate correlation between pre-existing cardiac disease and early death from acute MI in our cohort of patients.…”

The measurement of cardiac troponins in patients undergoing major orthopaedic surgery

“…We read with interest the article of Talsnes et al who concluded that laboratory analyses on cardiospecific troponins, namely, troponin T, provide useful information on the risk of fatal outcome in elderly patients undergoing hip fracture surgery [1]. The development and introduction into routine laboratory practice of assays for measuring cardiospecific troponins has revolutionised the diagnostic approach of patients with chest pain and suspected acute coronary syndrome (ACS).…”