title: Adverse cardiac events in 56,000 orthopaedic trauma patients: Does anatomic area make a difference?
abstract: OBJECTIVE
  Postoperative cardiac events in orthopaedic trauma patients constitute severe morbidity and mortality. It is therefore increasingly important to determine patient risk factors that are predictive of postoperative myocardial infarctions and cardiac arrests. This study sought to assess if there is an association between anatomic area and cardiac complications in the orthopaedic trauma patient.
  
  
  METHODS
  From 2006-2013, a total of 361,402 orthopaedic patients were identified in the NSQIP database using Current Procedural Terminology (CPT) codes. Of these, 56,336 (15.6%) patients were identified as orthopaedic trauma patients broken down by anatomic region: 11,905 (21.1%) upper extremity patients (UE), 29,009 (51.5%) hip/pelvis patients (HP), and 15,422 (27.4%) lower extremity patients (LE) using CPT codes. Patients were defined as having adverse cardiac events if they developed myocardial infarctions or cardiac arrests within 30days after surgery. Chi-squared analysis was used to determine if there was an association between anatomic area and rates of cardiac events. Multivariate logistical analysis was used with over 40 patient characteristics including age, gender, history of cardiac disease, and anatomic region as independent predictors to determine whether anatomic area significantly predicted the development of cardiac complications.
  
  
  RESULTS
  There were significant differences in baseline demographics among the three groups: HP patients had the greatest average age (77.6 years) compared to 54.8 years for UE patients and 54.1 years in LE patients (p<0.001). HP patients also had the highest average ASA score (3.0) (p<0.001). There was a significant difference in adverse cardiac events based on anatomic area: 0.27% (32/11,905) UE patients developed cardiac complications compared to 2.15% (623/29,009) HP patients and 0.61% (94/15,422) LE patients. After multivariate analysis, HP patients were significantly more likely to develop cardiac complications compared to both UE patients (OR: 6.377, p=0.014) and LE patients (OR: 2.766, p=0.009).
  
  
  CONCLUSIONS
  There is a significant difference in adverse cardiac events following orthopaedic trauma based on anatomic region. Hip/Pelvis surgery appeared to be a significant risk factor in developing an adverse cardiac event. Further studies should investigate why hip/pelvic patients are at a higher risk of adverse cardiac events.
authors.affiliation: Department of Orthopaedics, Geisinger Medical Center, Danville, PA, United States.
authors.forename: Adam K
authors.initials: AK
authors.lastname: Lee
authors.affiliation: Vanderbilt Orthopaedics Institute Center for Health Policy, Vanderbilt University Medical Center, Nashville, TN, United States.
authors.forename: Ashley C
authors.initials: AC
authors.lastname: Dodd
authors.affiliation: Vanderbilt Orthopaedics Institute Center for Health Policy, Vanderbilt University Medical Center, Nashville, TN, United States.
authors.forename: Nikita
authors.initials: N
authors.lastname: Lakomkin
authors.affiliation: Vanderbilt Orthopaedics Institute Center for Health Policy, Vanderbilt University Medical Center, Nashville, TN, United States.
authors.forename: Mahesh
authors.initials: M
authors.lastname: Yarlagadda
authors.affiliation: Vanderbilt Orthopaedics Institute Center for Health Policy, Vanderbilt University Medical Center, Nashville, TN, United States.
authors.forename: A Alex
authors.initials: AA
authors.lastname: Jahangir
authors.affiliation: Vanderbilt Orthopaedics Institute Center for Health Policy, Vanderbilt University Medical Center, Nashville, TN, United States.
authors.forename: Cory A
authors.initials: CA
authors.lastname: Collinge
authors.affiliation: Vanderbilt Orthopaedics Institute Center for Health Policy, Vanderbilt University Medical Center, Nashville, TN, United States. Electronic address: manish.sethi@vanderbilt.edu.
authors.forename: Manish K
authors.initials: MK
authors.lastname: Sethi
mesh_terms: D000368:Aged; D000776:Anesthesiology / Q000379:methods; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality*; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D050723:Fractures, Bone / Q000401:mortality / Q000601:surgery*; D006620:Hip Fractures / Q000150:complications / Q000401:mortality / Q000601:surgery*; D006801:Humans; D035002:Lower Extremity / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects* / Q000401:mortality; D010384:Pelvic Bones / Q000293:injuries*; D011183:Postoperative Complications / Q000401:mortality*; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D014481:United States; D034941:Upper Extremity / Q000293:injuries*
keywords: Cardiac arrest; Cardiac complication; Hip/pelvis; Lower extremity; Myocardial infarction; Upper extremity