title: Incidence of post-operative troponin I rises and 1-year mortality after emergency orthopaedic surgery in older patients.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Aged Care, The Northern Hospital, Epping, Victoria, Australia. carol.chong@nh.org.au
authors.forename: Carol P
authors.initials: CP
authors.lastname: Chong
authors.forename: Que T
authors.initials: QT
authors.lastname: Lam
authors.forename: Julie E
authors.initials: JE
authors.lastname: Ryan
authors.forename: Rabindra N
authors.initials: RN
authors.lastname: Sinnappu
authors.forename: Wen Kwang
authors.initials: WK
authors.lastname: Lim
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D005260:Female; D050723:Fractures, Bone / Q000097:blood / Q000401:mortality* / Q000601:surgery*; D006331:Heart Diseases / Q000097:blood / Q000401:mortality*; D006801:Humans; D015994:Incidence; D007297:Inpatients / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000401:mortality; D010045:Outpatients / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000097:blood / Q000401:mortality*; D011237:Predictive Value of Tests; D012307:Risk Factors; D019210:Troponin I / Q000097:blood*
chemical_list: D019210:Troponin I