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. 2015 Jun 15;115(12):1643-8.
doi: 10.1016/j.amjcard.2015.03.003. Epub 2015 Mar 23.

Relation of perioperative elevation of troponin to long-term mortality after orthopedic surgery

Brandon S Oberweis  1 , Nathaniel R Smilowitz  2 , Swetha Nukala  3 , Andrew Rosenberg  4 , Jinfeng Xu  2 , Steven Stuchin  5 , Richard Iorio  5 , Thomas Errico  5 , Martha J Radford  2 , Jeffrey S Berger  6
Affiliations

Relation of perioperative elevation of troponin to long-term mortality after orthopedic surgery

Brandon S Oberweis et al. Am J Cardiol. .

Abstract

Myocardial necrosis in the perioperative period of noncardiac surgery is associated with short-term mortality, but long-term outcomes have not been characterized. We investigated the association between perioperative troponin elevation and long-term mortality in a retrospective study of consecutive subjects who underwent hip, knee, and spine surgery. Perioperative myocardial necrosis and International Classification of Disease, Ninth Revision-coded myocardial infarction (MI) were recorded. Long-term survival was assessed using the Social Security Death Index database. Logistic regression models were used to identify independent predictors of long-term mortality. A total of 3,050 subjects underwent surgery. Mean age was 60.8 years, and 59% were women. Postoperative troponin was measured in 1,055 subjects (34.6%). Myocardial necrosis occurred in 179 cases (5.9%), and MI was coded in 20 (0.7%). Over 9,015 patient-years of follow-up, 111 deaths (3.6%) occurred. Long-term mortality was 16.8% in subjects with myocardial necrosis and 5.8% with a troponin in the normal range. Perioperative troponin elevation (hazard ratio 2.33, 95% confidence interval 1.33 to 4.10) and coded postoperative MI (adjusted hazard ratio 3.51, 95% confidence interval 1.44 to 8.53) were significantly associated with long-term mortality after multivariable adjustment. After excluding patients with coronary artery disease and renal dysfunction, myocardial necrosis remained associated with long-term mortality. In conclusion, postoperative myocardial necrosis is common after orthopedic surgery. Myocardial necrosis is independently associated with long-term mortality at 3 years and may be used to identify patients at higher risk for events who may benefit from aggressive management of cardiovascular risk factors.

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Figures

Figure 1
Figure 1
Long-term post-operative mortality by troponin measurement.
Figure 2
Figure 2
Mortality by perioperative troponin measurement: sensitivity analysis with coronary artery disease and advanced kidney disease.
See this image and copyright information in PMC

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