Predictors of perioperative myocardial injury and postoperative recovery in non-cardiac surgery

Abstract Background Postoperative elevation of cardiac Troponin I (MTNI) reflects perioperative myocardial injury, while length of hospital stay (LOS) represents the overall postoperative recovery burden. This study aimed to identify independent predictors of MTNI elevation and prolonged LOS in patients undergoing non-cardiac surgery. Methods A total of 104 patients were evaluated with demographic data, perioperative hemodynamic parameters, laboratory indices, and surgical/anesthetic characteristics. Troponin I was measured pre- and postoperatively. Multivariable linear regression was performed for ln(MTNI) and LOS. Results Postoperative myocardial injury was strongly associated with age and the need for vasopressors. Each additional year of age was associated with approximately 4% higher MTNI (B=0.038, p0.001). Patients requiring vasopressors demonstrated ~2.8-fold higher MTNI (B=1.330, p=0.002). The simple correlation between vasopressor use and postoperative MTNI ranged from r=0.32–0.40 (p≤0.05). In contrast, LOS was not independently determined by MTNI (p=0.092). The strongest predictors of prolonged LOS were Postoperative CRP (B=0.224, p0.001), Surgery duration (B=0.010, p0.001), Age (B=0.019, p=0.016). Together, these factors explained ~54% of LOS variability. MTNI did not remain an independent determinant once systemic inflammation and surgical burden were accounted for. Conclusions Perioperative myocardial injury is primarily driven by advanced age and hemodynamic instability requiring vasopressors. Postoperative recovery (LOS), however, is more strongly influenced by systemic inflammation and surgical complexity rather than myocardial injury itself. Incorporating these predictors into preoperative risk assessment may enhance individualized perioperative care.