Factors Associated With Postoperative High-Sensitivity Cardiac Troponin T Elevation After Thoracic Surgery: A Single-Centre Retrospective Cohort Study

AIM: To examine perioperative factors associated with postoperative high-sensitivity cardiac troponin T (hs-cTnT) elevation after thoracic surgery. METHODS: This single-centre retrospective cohort study screened 588 consecutive records of patients who underwent thoracic surgery between June 2020 and June 2023, counting only the first eligible operation for each patient. After the exclusion of 128 records, all 460 eligible patients were included in the analysis. The outcome was defined as any hs-cTnT value ≥0.014 µg/L (14 ng/L) on postoperative day 1, 3, or 5. Eleven variables were entered simultaneously into a binary logistic regression model, with surgical method represented by indicator variables. Age was entered in years, and its odds ratio (OR) was expressed per 10-year increase; other continuous variables were analysed in their original units. RESULTS: Postoperative hs-cTnT elevation occurred in 155 of 460 patients (33.7%). In the multivariable model, age (OR 1.80, 95% CI 1.23–2.63), procedure type (wedge resection: OR 4.47, 95% CI 1.57–12.71; segmentectomy/lobectomy: OR 5.52, 95% CI 2.04–14.96; oesophageal surgery: OR 27.96, 95% CI 5.50–142.27; each compared with other thoracic procedures), operation duration (OR 1.53 per hour, 95% CI 1.21–1.93), preoperative creatinine (OR 1.021 per µmol/L, 95% CI 1.007–1.035), preoperative potassium (OR 3.59 per mmol/L, 95% CI 1.84–7.02), and pre-existing atrial fibrillation (OR 5.56, 95% CI 1.84–16.83) were associated with the outcome. Postoperative day-1 haemoglobin showed an inverse association that did not reach statistical significance (OR 0.972 per g/L, 95% CI 0.942–1.002; p = 0.069), and the inverse association with ejection fraction was also not significant (OR 0.905 per %, 95% CI 0.772–1.060; p = 0.216). CONCLUSIONS: Older age, procedure type, longer operation duration, higher preoperative creatinine, higher preoperative potassium, and pre-existing atrial fibrillation were associated with postoperative hs-cTnT elevation after multivariable adjustment. These associations do not establish causality or constitute a validated prediction model; rather, they generate hypotheses for the prospective evaluation of postoperative monitoring strategies.