Post-operative troponin I rise in older patients undergoing emergency orthopaedic surgery was independently associated with increased 1-year all-cause mortality (OR 12.0; 95% CI 1.4-104.8; P=0.025).
Cohort (n=102)
Does post-operative troponin I rise predict 1-year mortality and cardiac events in older patients undergoing emergency orthopaedic surgery?
Post-operative troponin I rise occurs in over half of older patients undergoing emergency orthopaedic surgery and is a strong independent predictor of 1-year mortality and cardiac events.
Odds Ratio: 12 (95% CI 1.4–104.8)
Absolute Event Rate: 37% vs 2.1%
p-value: p=0.025
OBJECTIVES: to determine the incidence of post-operative troponin I rises and its association with 1-year all-cause mortality and cardiac events after emergency orthopaedic-geriatric surgery, which has not been studied before. METHODS: one hundred and two patients over the age of 60 were recruited and followed up at 1 year. All consented to serial troponin I measurements peri-operatively. RESULTS: the incidence of a troponin I rise post-operatively was 52.9%. Post-operative acute myocardial infarction was diagnosed in 9.8% and at 1 year, 70% of these patients were dead. At 1 year, 32.4% (33/102) had sustained a cardiac event (myocardial infarction, congestive cardiac failure, atrial fibrillation or major arrhythmia) and using multivariate analysis, post-operative troponin rise (OR 3.9, 95% CI 1.4-10.7, P = 0.008) was an independent predictor of this. Half of the patients with a troponin rise had a cardiac event compared to 18.8% without a rise. All-cause mortality was 20.6% at 1 year; 37% with an associated post-operative troponin rise died versus 2.1% without a rise (P < 0.0001). Using multivariate analysis, only two factors were associated with 1-year all-cause mortality: post-operative troponin rise (OR 12.0, 95% CI 1.4-104.8, P = 0.025) and sustaining a post-operative in-hospital cardiac event (OR 6.6, 95% CI 1.7-25.6, P = 0.006). Furthermore, patients with higher troponin levels had significantly worse survival. CONCLUSIONS: there is a high incidence of post-operative troponin I rises in older patients undergoing emergency orthopaedic surgery with 1-year mortality and cardiac events being significantly increased in these patients. Future studies are needed to determine whether any intervention can improve outcome for these patients.
Chong et al. (Thu,) conducted a cohort in Emergency orthopaedic surgery (n=102). Post-operative troponin I rise vs. No post-operative troponin I rise was evaluated on 1-year all-cause mortality (OR 12.0, 95% CI 1.4-104.8, p=0.025). Post-operative troponin I rise in older patients undergoing emergency orthopaedic surgery was independently associated with increased 1-year all-cause mortality (OR 12.0; 95% CI 1.4-104.8; P=0.025).