Elevated serum cardiac troponin I in older patients with hip fracture: incidence and prognostic significance

Fisher, Alexander A.; Southcott, Emma; Goh, Shyan; Srikusalanukul, Wichat; Hickman, Peter E.; Davis, Michael W.; Potter, Julia M.; Budge, Marc; Smith, Paul N.

doi:10.1007/s00402-007-0554-x

Cited by 40 publications

(38 citation statements)

References 28 publications

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“…The present study is the largest series of subjects undergoing major orthopedic surgery with troponin measurements and long-term follow-up. Our data support the findings of small orthopedic surgery studies, 9–14,19,20 and augment the short-term results of large prospective registries of subjects undergoing non-cardiac surgery. 15,16 In the large, prospective Vascular Events in Non-Cardiac Surgery Subjects Cohort Evaluation (VISION) study, elevated perioperative troponin elevations correlated with 30-day mortality.…”

Section: Discussionsupporting

confidence: 86%

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: Discussionsupporting

confidence: 86%

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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“…Our study showed an overall incidence of myocardial necrosis and major bleeding of 5.8% and 5.4%, respectively. Previous studies have shown an incidence of perioperative myocardial necrosis ranging from 1% to 53% 3–9 , depending on the study population. For example, Chong et al found an incidence of perioperative myocardial necrosis of 53% in subjects with a mean age of 79 years undergoing emergency orthopedic surgery 4 .…”

Section: Discussionmentioning

confidence: 99%

“…Perioperative thrombotic complications are a major cause of morbidity and mortality, occurring in 1–53% of cases depending on type of surgery, comorbidities present, and outcome ascertainment 1–9 . On the opposite end of the haemostatic equilibrium, major perioperative bleeding increases the risk of reoperation, overall length of stay, and hospital costs 10 .…”

mentioning

confidence: 99%

Thrombotic and bleeding complications after orthopedic surgery

Oberweis

Nukala

Rosenberg

et al. 2013

American Heart Journal

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Background Thrombotic and bleeding complications are major concerns during orthopedic surgery. Given the frequency of orthopedic surgical procedures and the limited data in the literature, we sought to investigate the incidence and risk factors for thrombotic (myocardial necrosis and infarction) and bleeding events in patients undergoing orthopedic surgery. Methods and Results We performed a retrospective cohort analysis of 3,082 consecutive subjects ≥ 21 years of age undergoing hip, knee, or spine surgery between November 1, 2008, and December 31, 2009. Patient characteristics were ascertained using ICD-9 diagnosis coding and retrospective review of medical records, and laboratory/blood bank databases. In-hospital outcomes included myocardial necrosis (elevated troponin), major bleeding, coded myocardial infarction (MI), and coded hemorrhage as defined by ICD-9 coding. Of the 3,082 subjects, mean age was 60.8 ± 13.3 years and 59% were female. Myocardial necrosis, coded MI, major bleeding, and coded hemorrhage occurred in 179 (5.8%), 20 (0.7%), 165 (5.4%), and 26 (0.8%) subjects, respectively. Increasing age (P<0.001), CAD (P<0.001), cancer (P=0.004), and chronic kidney disease (P=0.01) were independent predictors of myocardial necrosis, while procedure type (P<0.001), cancer (P<0.001), female sex (P<0.001), CAD (P<0.001), and COPD (P=0.01) were independent predictors of major bleeding. Conclusion There is a delicate balance between thrombotic and bleeding events in the perioperative period following orthopedic surgery. Perioperative risk of both thrombosis and bleeding deserve careful attention in preoperative evaluation and future prospective studies aimed at attenuating this risk are warranted.

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“…11,19Y22 Earlier studies on myocardial injury related to hip fracture have been relatively small and most of them focus on elderly or patients with high cardiac risk. 6,11,20,21 To date, no comprehensive analysis of perioperative myocardial infarctions in hip fracture patients has been performed, and none of the earlier studies have used serial ECG recordings to assess myocardial ischemia or infarction. The purpose of this prospective study was to determine the incidence of myocardial infarctions in an unselected population of patients with acute hip fracture and to assess the characteristics and risk factors of perioperative myocardial infarctions in this fragile patient group.…”

Section: Introductionmentioning

confidence: 99%

Perioperative myocardial infarctions are common and often unrecognized in patients undergoing hip fracture surgery

Hietala

Strandberg

et al. 2013

Journal of Trauma and Acute Care Surgery

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Elevated serum cardiac troponin I in older patients with hip fracture: incidence and prognostic significance

Abstract: Peri-operative myocardial injury is common in older HF patients but is frequently unrecognised clinically. Elevated blood cTnI level is an independent predictor of prolonged length of hospital stay (>or=20 days), need for long-term RCF and mortality (if cTnI >or=1 microg/l).

Cited by 40 publications

References 28 publications

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

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

Thrombotic and bleeding complications after orthopedic surgery

Perioperative myocardial infarctions are common and often unrecognized in patients undergoing hip fracture surgery

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