Peri‐operative silent myocardial ischaemia in patients undergoing lower limb joint replacement surgery: an indicator of postoperative morbidity or mortality?

French, G. W. G.; Lam, Wei-Haur; Rashid, Zahir A.; Sear, J.W.; Foëx, P.; Howell, Simon

doi:10.1046/j.1365-2044.1999.00713.x

Cited by 15 publications

(7 citation statements)

References 25 publications

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“…The myocardial infarction rate in our study was 0.35%, with mortality reported following 273 (14.3%) of 1,906 procedures. This did not, however, take into consideration the possibility of silent myocardial infarction 33 .…”

Section: Discussionmentioning

confidence: 99%

Ten-Year Trends in Medical Complications Following 540,623 Primary Total Hip Replacements from a National Database

Partridge

Jameson

Baker

et al. 2018

The Journal of Bone and Joint Surgery

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Background:More than 75,000 total hip replacements were performed in England and Wales in 2014, and this figure is predicted to increase. Trends in mortality and complications following total hip replacement from 2005 to 2014 were evaluated to quantify risk and to identify “at-risk” groups to better inform recommendations for patient care.Methods:Our primary analysis estimated 90-day inpatient mortality following total hip replacement using Hospital Episode Statistics data from 2005 to 2014. Secondary analyses explored 30-day rates of lower respiratory tract infection, renal failure, myocardial infarction, pulmonary embolism, deep-vein thrombosis, cerebrovascular accident, and Clostridium difficile. Hierarchical logistic regression was used to estimate population averages, adjusting for time and prognostic covariates.Results:From January 2005 to July 2014, a total of 540,623 total hip replacements were reported. The 90-day mortality rate dropped steadily, from 0.60% in 2005 to 0.15% in 2014. Reported postoperative complications (with the exception of lower respiratory tract infection and renal failure) reduced year-on-year, despite a steady rise in the average Charlson Comorbidity Index score. The 30-day rate of lower respiratory tract infection and renal failure increased from 0.54% to 0.84% and 0.21% to 1.09%, respectively. The risk of mortality was significantly higher for those who developed a lower respiratory tract infection (odds ratio [OR] = 42.3) or renal failure (OR = 36.5) than for those who developed pulmonary embolism (OR = 10.9) or deep-vein thrombosis (OR = 2.6).Conclusions:Despite a population with increasing levels of comorbidity, indicators of quality of care improved from 2005 to 2014, with the exception of the rates of lower respiratory tract infection and renal failure. Postoperative care should focus on reducing the risk of lower respiratory tract infection and renal failure, both of which increased and were strongly associated with mortality. Moreover, they appeared to occur in identifiable high-risk groups; modifications to routine care should be considered for these patients.Level of Evidence:Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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Section: Discussionmentioning

confidence: 99%

Ten-Year Trends in Medical Complications Following 540,623 Primary Total Hip Replacements from a National Database

Partridge

Jameson

Baker

et al. 2018

The Journal of Bone and Joint Surgery

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“…However, the incidence of myocardial ischaemia, which may be considered a surrogate for myocardial events, is relatively much higher and can be detected and quantified by Holter continuous ambulatory electrocardiogram (ECG) monitoring [12–14]. Previous studies have reported that silent myocardial ischaemia (SMI) can be found in up to 30% of patients during the perioperative period following non‐cardiac surgery [15–20]. Both increased incidence and duration of perioperative SMI are associated with adverse outcomes [21–23].…”

Section: Introductionmentioning

confidence: 99%

Silent myocardial ischaemia and haemoglobin concentration: a randomized controlled trial of transfusion strategy in lower limb arthroplasty

et al. 2006

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In patients without preoperative evidence of myocardial ischaemia undergoing elective hip and knee replacement surgery, a restrictive transfusion strategy seems unlikely to be associated with an increased incidence of SMI. A proportion of these patients experience moderate SMI, regardless of the transfusion trigger. Use of a restrictive transfusion strategy did not increase length of hospital stay, and use of this strategy would lead to a significant reduction in red cell transfusion in orthopaedic surgery. Our data did not indicate any potential for harm in employing such a strategy in patients with no prior evidence of cardiac ischaemia who were undergoing elective orthopaedic surgery.

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“…Methods available for the detection of damage include ambulatory electrocardiograph (ECG) recording, cardiac scanning and the measurement of blood concentrations of cardiac‐specific proteins. We previously reported the poor specificity of ambulatory ECG as an indicator of postoperative cardiovascular complications in noncardiac surgical patients [1–3].…”

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confidence: 99%

Increases in serum concentrations of cardiac proteins and the prediction of early postoperative cardiovascular complications in noncardiac surgery patients

et al. 2000

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SummaryWe investigated the use of measurements of serum concentrations of the cardiac proteins troponins I and T as biochemical markers of myocardial cell damage in 80 patients undergoing vascular or major orthopaedic surgery. Holter electrocardiographic monitoring was carried out before surgery and for 3 days after surgery. Blood samples for troponins I and T and creatine kinase-MB isoenzyme were taken on each of these 4 days. Outcome was assessed at 3 months using a patient questionnaire, general practitioner follow-up and case notes review. Silent postoperative myocardial ischaemia was detected in 21 patients; increases in troponins I and T and creatine kinase-MB occurred in four, six and 17 of these patients, respectively. Eight patients suffered major postoperative complications (cardiac death, myocardial ischaemia, congestive cardiac failure, unstable angina and cerebrovascular accident) and 21 minor complications (poorly controlled hypertension needing increased or new additional treatment, palpitations, increased tiredness or shortness of breath in the absence of known respiratory disease). There were no associations between postoperative ischaemia and cardiac protein concentrations. The relative odds for the associations of major adverse outcome at 3 months after surgery and postoperative ischaemia or increased serum concentrations of the three proteins were 5.39 [95% confidence intervals 1.16±27.67] for postoperative ischaemia; 5.64 [1.07±31.00] for creatine kinase-MB isoenzyme; 17.00 [2.20±116.54] for troponin T and 13.20 [1.12±135.00] for troponin I. We found troponin T to be the only prospective marker for both major and minor cardiovascular complications (relative odds 10.65 [1.26±252.88]).

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Peri‐operative silent myocardial ischaemia in patients undergoing lower limb joint replacement surgery: an indicator of postoperative morbidity or mortality?

Cited by 15 publications

References 25 publications

Ten-Year Trends in Medical Complications Following 540,623 Primary Total Hip Replacements from a National Database

Ten-Year Trends in Medical Complications Following 540,623 Primary Total Hip Replacements from a National Database

Silent myocardial ischaemia and haemoglobin concentration: a randomized controlled trial of transfusion strategy in lower limb arthroplasty

Increases in serum concentrations of cardiac proteins and the prediction of early postoperative cardiovascular complications in noncardiac surgery patients

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