title: Relation of perioperative elevation of troponin to long-term mortality after orthopedic surgery.
abstract: Myocardial necrosis in the perioperative period of noncardiac surgery is associated with short-term mortality, but long-term outcomes have not been characterized. We investigated the association between perioperative troponin elevation and long-term mortality in a retrospective study of consecutive subjects who underwent hip, knee, and spine surgery. Perioperative myocardial necrosis and International Classification of Disease, Ninth Revision-coded myocardial infarction (MI) were recorded. Long-term survival was assessed using the Social Security Death Index database. Logistic regression models were used to identify independent predictors of long-term mortality. A total of 3,050 subjects underwent surgery. Mean age was 60.8 years, and 59% were women. Postoperative troponin was measured in 1,055 subjects (34.6%). Myocardial necrosis occurred in 179 cases (5.9%), and MI was coded in 20 (0.7%). Over 9,015 patient-years of follow-up, 111 deaths (3.6%) occurred. Long-term mortality was 16.8% in subjects with myocardial necrosis and 5.8% with a troponin in the normal range. Perioperative troponin elevation (hazard ratio 2.33, 95% confidence interval 1.33 to 4.10) and coded postoperative MI (adjusted hazard ratio 3.51, 95% confidence interval 1.44 to 8.53) were significantly associated with long-term mortality after multivariable adjustment. After excluding patients with coronary artery disease and renal dysfunction, myocardial necrosis remained associated with long-term mortality. In conclusion, postoperative myocardial necrosis is common after orthopedic surgery. Myocardial necrosis is independently associated with long-term mortality at 3 years and may be used to identify patients at higher risk for events who may benefit from aggressive management of cardiovascular risk factors.
authors.affiliation: Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York.
authors.forename: Brandon S
authors.initials: BS
authors.lastname: Oberweis
authors.affiliation: Division of Cardiology, Department of Medicine, New York University Langone Medical Center, New York, New York.
authors.forename: Nathaniel R
authors.initials: NR
authors.lastname: Smilowitz
authors.affiliation: Department of Clinical Quality and Clinical Effectiveness, New York University Langone Medical Center, New York, New York.
authors.forename: Swetha
authors.initials: S
authors.lastname: Nukala
authors.affiliation: Department of Anesthesiology, New York University Langone Medical Center, New York, New York.
authors.forename: Andrew
authors.initials: A
authors.lastname: Rosenberg
authors.affiliation: Division of Cardiology, Department of Medicine, New York University Langone Medical Center, New York, New York.
authors.forename: Jinfeng
authors.initials: J
authors.lastname: Xu
authors.affiliation: Department of Orthopedic Surgery, New York University Langone Medical Center, New York, New York.
authors.forename: Steven
authors.initials: S
authors.lastname: Stuchin
authors.affiliation: Department of Orthopedic Surgery, New York University Langone Medical Center, New York, New York.
authors.forename: Richard
authors.initials: R
authors.lastname: Iorio
authors.affiliation: Department of Orthopedic Surgery, New York University Langone Medical Center, New York, New York.
authors.forename: Thomas
authors.initials: T
authors.lastname: Errico
authors.affiliation: Division of Cardiology, Department of Medicine, New York University Langone Medical Center, New York, New York.
authors.forename: Martha J
authors.initials: MJ
authors.lastname: Radford
authors.affiliation: Division of Cardiology, Department of Medicine, New York University Langone Medical Center, New York, New York; Division of Vascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, New York. Electronic address: jeffrey.berger@nyumc.org.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Berger
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000401:mortality*; D009336:Necrosis; D019637:Orthopedic Procedures; D059035:Perioperative Period; D011183:Postoperative Complications / Q000097:blood* / Q000401:mortality*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D014336:Troponin / Q000097:blood*
chemical_list: D015415:Biomarkers; D014336:Troponin