Association of preoperative blood biomarkers with postoperative major adverse cardiac events and mortality in major orthopaedic surgery: a systematic review and meta-analysis

Abstract

Objective: The association between preoperative blood biomarkers and major adverse cardiac events (MACEs) as well as mortality after major orthopaedic surgery remains unclear. This study aimed to assess the association between preoperative blood biomarkers and postoperative MACEs as well as all-cause mortality in patients undergoing major orthopaedic surgery.

Design: A systematic review and meta-analysis.

Data sources: PubMed, EMBASE, the Cochrane Controlled Trials Register and Cochrane Database of Systematic Reviews from inception to 20 October 2024 were searched.

Eligibility criteria: Observational or experimental studies reporting the correlation between preoperative blood biomarkers and postoperative MACEs-categorised as short-term (within 3 months) or long-term (beyond 3 months)-and all-cause mortality in patients undergoing major orthopaedic surgery.

Data extraction and synthesis: Data from studies reporting OR or HR and its 95% CI were pooled for analysis using random-effects model.

Results: 21 preoperative blood-based biomarkers from 80 studies with 226 468 patients were analysed. Elevated preoperative cardiac biomarkers were correlated with a heightened risk of MACEs within 3 months (natriuretic peptide: OR 3.37, 95% CI 2.07 to 5.47, I²=87.9%; cardiac troponin: OR 4.89, 95% CI 1.52 to 15.75, I²=69.5%) with significant heterogeneity. Only natriuretic peptide was associated with a high-risk long-term MACEs (>3 months) (OR 3.52, 95% CI 1.73 to 7.17, I²=86.2%). In contrast, cardiac biomarkers were not identified as having prognostic value for all-cause mortality in this patient cohort. Additionally, an increased risk of all-cause mortality was associated with preoperative abnormal levels of albumin (OR 1.15, 95% CI 1.06 to 1.24, I²=84.8%), creatinine (OR 1.54, 95% CI 1.12 to 1.95, I²=0), 25(OH)D (OR 1.58, 95% CI 1.01 to 2.14, I²=0) and glomerular filtration rate (GFR) (OR 1.12, 95% CI 1.06 to 1.17, I²=0), rather than cardiac biomarkers.

Conclusions: The study proposed that cardiac biomarkers assessed before surgery could offer prognostic insight into short-term MACEs, while preoperative abnormal levels of albumin, creatinine, 25 (OH)D and GFR might be prognostic valuable for all-cause mortality following major orthopaedic surgery.

Prospero registration number: CRD42022352091.

Keywords: Anaesthesia in orthopaedics; Meta-Analysis; Mortality.

Figure 1. Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram.

Figure 2. Risk of bias graph: review authors’ judgement about each risk of bias item presented as percentages across all included studies.

Figure 3. Risk of major adverse cardiac event for patients with elevated preoperative BNP or NT-proBNP versus those with normal levels. BNP, B-type natriuretic peptide; NT-proBNP, N-terminal pro-BNP.

Figure 4. Risk of major adverse cardiac event for patients with elevated preoperative cardiac troponin versus those with normal levels during short-term follow-up.