Clinical presentation and outcome of perioperative myocardial infarction in the very elderly following hip fracture surgery

Abstract

Background Patterns of clinical symptoms and outcomes of Perioperative Myocardial Infarction (PMI) in elderly after hip fracture repair surgery are not well defined. Methods A retrospective 1:2 case-control study in a cohort of 1,212 elderly patients undergoing hip fracture surgery from 1988–2002 in Olmsted County, Minnesota. Results The mean age was 85.3±7.4 with 76% of population being female. PMI occurred in 167 (13.8%) patients within 7 days, of which 153 (92%) occurred in first 48 hours; 75% of patients were asymptomatic. Among patients with PMI, in-hospital mortality was 14.4 %, 30-day mortality was 29 (17.4%), and one year mortality was 66 (39.5%). PMI was associated with a higher inpatient mortality rate (OR, 15.1; CI 4.6-48.8), 30-day mortality (HR, 4.3; CI, 2.1-8.9) and one-year mortality (HR, 1.9; CI, 1.4-2.7). Conclusion Elderly patients, after hip fracture surgery, have a higher incidence of PMI and mortality than what guidelines indicate. The majority of elderly patients with PMI did not experience ischemic symptoms and required cardiac biomarkers for diagnosis. The results of our study support the measurement of troponin in postoperative elderly patients for the diagnosis of PMI, in order to implement in-hospital preventive strategies to reduce PMI associated mortality.

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.…”

Management of Postoperative Complications

“…In this study, approximately 14% of subjects experienced an myocardial infarction after hip fracture repair, 75% of which were asymptomatic. 11 This study underscores the need to define the cumulative stressors to the cardiovascular system following surgery to reduce this serious and silent complication.…”

Assessing Association Among Anemia, Bleeding, and Transfusion with Long-Term Mortality

“…Specifically, postoperative complications and new vital organ impairments have been associated independently with short-and long-term mortality after orthopedic surgery. 5 Thus, we would argue that in this study, no inclusion of an entire comorbidity burden, impaired functional status, and postoperative complications as potential confounders would have tampered with inferences of the multivariate Cox proportional hazards regression analysis for adjusted long-term mortality after orthopedic surgery.…”