title: Do orthopaedic trauma patients develop higher rates of cardiac complications? An analysis of 56,000 patients.
abstract: OBJECTIVE
  Less than 5 % of orthopaedic patients develop postoperative cardiac complications; however, there are little data suggesting which orthopaedic patients are at greatest risk. In an era where emerging reimbursement models place an emphasis on quality, reducing complications through perioperative planning will be of paramount importance for orthopaedic surgeons. The purpose of this study was to determine whether orthopaedic trauma patients are at greater risk for postoperative cardiac complications and to reveal which factors are most predictive of these complications.
  
  
  METHODS
  All orthopaedic patients were identified in the 2006-2013 ACS-NSQIP database. Cardiac complications were defined as cardiac arrests or myocardial infarctions within 30 days following surgery. Chi squared analysis determined differences in cardiac complication rates between trauma and non-trauma patients. Bivariate analysis incorporating over 40 patient/surgical characteristics determined significant associations between patient characteristics and cardiac complications. These factors were incorporated into a multivariate regression model to identify predictive risk factors for cardiac complications.
  
  
  RESULTS
  The presence of a traumatic injury resulted in greater odds of developing cardiac complications (OR: 1.645, p < 0.001). The cardiac complication rate in the trauma group was 1.3 % compared to 0.3 % in the non-trauma group (p < 0.001). For trauma patients, ventilator use (OR: 27.354, p = 0.004), recent transfusion (OR: 19.780, p = 0.001), and history of coma (OR: 17.922, p = 0.020) were most predictive of cardiac complications.
  
  
  CONCLUSIONS
  Orthopaedic trauma patients are more likely to develop cardiac complications than non-trauma patients. To reduce cardiac complications, orthopaedic traumatologists should be aware of patient risk factors including ventilator use, blood transfusion, and history of coma.
authors.affiliation: The Vanderbilt Orthopaedic Institute Center for Health Policy, 1215 21st Avenue South, Suite 4200, Medical Center East, South Tower, Nashville, TN, 37232, USA.
authors.forename: A C
authors.initials: AC
authors.lastname: Dodd
authors.affiliation: The Vanderbilt Orthopaedic Institute Center for Health Policy, 1215 21st Avenue South, Suite 4200, Medical Center East, South Tower, Nashville, TN, 37232, USA.
authors.forename: N
authors.initials: N
authors.lastname: Lakomkin
authors.affiliation: The Vanderbilt Orthopaedic Institute Center for Health Policy, 1215 21st Avenue South, Suite 4200, Medical Center East, South Tower, Nashville, TN, 37232, USA.
authors.forename: V
authors.initials: V
authors.lastname: Sathiyakumar
authors.affiliation: The Vanderbilt Orthopaedic Institute Center for Health Policy, 1215 21st Avenue South, Suite 4200, Medical Center East, South Tower, Nashville, TN, 37232, USA.
authors.forename: W T
authors.initials: WT
authors.lastname: Obremskey
authors.affiliation: The Vanderbilt Orthopaedic Institute Center for Health Policy, 1215 21st Avenue South, Suite 4200, Medical Center East, South Tower, Nashville, TN, 37232, USA. manish.sethi@vanderbilt.edu.
authors.forename: M K
authors.initials: MK
authors.lastname: Sethi
mesh_terms: D000367:Age Factors; D000368:Aged; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D009104:Multiple Trauma / Q000601:surgery*; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000209:etiology; D019637:Orthopedic Procedures / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012307:Risk Factors; D012737:Sex Factors; D013714:Tennessee / Q000453:epidemiology
keywords: Anatomic area; Cardiac arrest; Myocardial infarction; Orthopaedic surgery; Risk factors