title: Does cardiology intervention improve mortality for post-operative troponin elevations after emergency orthopaedic-geriatric surgery? A randomised controlled study.
abstract: OBJECTIVE
  Troponin elevations are common after emergency orthopaedic surgery and confer a higher mortality at one year. The objective was to determine if comprehensive cardiology care after emergency orthopaedic surgery reduces mortality at one year in patients who sustain a post-operative troponin elevation versus standard care.
  
  
  METHODS
  A randomised controlled trial was conducted at a metropolitan teaching hospital in Melbourne, Australia. 187 consecutive patients were eligible with 70 patients randomised. Troponin I was tested peri-operatively and patients with a troponin elevation were randomised to cardiology care versus standard ward management. The main outcome measure was one year mortality.
  
  
  RESULTS
  The incidence of a post-operative troponin elevation was 37.4% (70/187) and these 70 patients were randomised. In-hospital cardiac complications were similar between the randomised groups: standard care (7/35 or 20.0%) versus cardiology care (8/35 or 22.9%). There was no difference in 1 year mortality between the randomised groups (6/35 or 17.1% in each group). Multivariate predictors of 1 year mortality were post-operative troponin elevation OR 4.3 (95% CI, 1.1-16.4, p=0.035), age OR 1.1 (95% CI, 1.02-1.2, p=0.016) and number of comorbidities OR 2.1 (95% CI, 1.3-3.5, p=0.004). At 1 year 35/187 (18.7%) sustained a cardiac complication and 23/35 (65.7%) had a troponin elevation.
  
  
  CONCLUSIONS
  There was no difference in mortality between patients with a post-operative troponin elevation randomised to cardiology care compared with standard care. Troponin elevation predicted one year mortality. Further research is needed to find an effective intervention to reduce mortality.
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: William J
authors.initials: WJ
authors.lastname: van Gaal
authors.forename: Julie E
authors.initials: JE
authors.lastname: Ryan
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Profitis
authors.forename: Judy
authors.initials: J
authors.lastname: Savige
authors.forename: Wen Kwang
authors.initials: WK
authors.lastname: Lim
mesh_terms: D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D015897:Comorbidity; D004632:Emergency Medical Services; D005260:Female; D050723:Fractures, Bone / Q000097:blood / Q000401:mortality* / Q000601:surgery; D006331:Heart Diseases / Q000097:blood / Q000401:mortality* / Q000601:surgery; D006801:Humans; D008297:Male; D019637:Orthopedic Procedures / Q000401:mortality*; D011183:Postoperative Complications / Q000097:blood / Q000401:mortality* / Q000601:surgery; D011184:Postoperative Period; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors; D016896:Treatment Outcome; D019210:Troponin I / Q000097:blood*
chemical_list: D019210:Troponin I