title: Postoperative Tachycardia: Clinically Meaningful or Benign Consequence of Orthopedic Surgery?
abstract: OBJECTIVE
  To determine the clinical significance of tachycardia in the postoperative period.
  
  
  METHODS
  Individuals 18 years or older undergoing hip and knee arthroplasty were included in the study. Two data sets were collected from different time periods: development data set from January 1, 2011, through December 31, 2011, and validation data set from December 1, 2012, through September 1, 2014. We used the development data set to identify the optimal definition of tachycardia with the strongest association with the vascular composite outcome (pulmonary embolism and myocardial necrosis and infarction). The predictive value of this definition was assessed in the validation data set for each outcome of interest, pulmonary embolism, myocardial necrosis and infarction, and infection using multiple logistic regression to control for known risk factors.
  
  
  RESULTS
  In 1755 patients in the development data set, a maximum heart rate (HR) greater than 110 beats/min was found to be the best cutoff as a correlate of the composite vascular outcome. Of the 4621 patients who underwent arthroplasty in the validation data set, 40 (0.9%) had pulmonary embolism. The maximum HR greater than 110 beats/min had an odds ratio (OR) of 9.39 (95% CI, 4.67-18.87; sensitivity, 72.5%; specificity, 78.0%; positive predictive value, 2.8%; negative predictive value, 99.7%) for pulmonary embolism. Ninety-seven patients (2.1%) had myocardial necrosis (elevated troponin). The maximum HR greater than 110 beats/min had an OR of 4.71 (95% CI, 3.06-7.24; sensitivity, 47.4%; specificity, 78.1%; positive predictive value, 4.4%; negative predictive value, 98.6%) for this outcome. Thirteen (.3%) patients had myocardial infarction according to our predetermined definition, and the maximum HR greater than 110 beats/min had an OR of 1.72 (95% CI, 0.47-6.27).
  
  
  CONCLUSIONS
  Postoperative tachycardia within the first 4 days of surgery should not be dismissed as a postoperative variation in HR, but may precede clinically significant adverse outcomes.
authors.affiliation: Division of Perioperative Medicine, Hospital for Special Surgery, New York, NY. Electronic address: sigmunda@hss.edu.
authors.forename: Alana E
authors.initials: AE
authors.lastname: Sigmund
authors.affiliation: Department of Mathematical Sciences, New Jersey Institute of Technology, Newark, NJ.
authors.forename: Yixin
authors.initials: Y
authors.lastname: Fang
authors.affiliation: NYU School of Medicine, NYU Langone Medical Center, New York, NY.
authors.forename: Matthew
authors.initials: M
authors.lastname: Chin
authors.affiliation: Division of Cardiology, Department of Medicine, Cardiovascular Clinical Research Center, NYU Langone Medical Center, New York, NY.
authors.forename: Harmony R
authors.initials: HR
authors.lastname: Reynolds
authors.affiliation: Division of General Internal Medicine and Clinical Innovation, Department of Medicine, NYU School of Medicine, NYU Langone Medical Center, New York, NY; Division of Healthcare Delivery Science, Department of Population Health, NYU Langone Medical Center, New York, NY.
authors.forename: Leora I
authors.initials: LI
authors.lastname: Horwitz
authors.affiliation: Division of Pulmonology and Critical Care, Department of Medicine, NYU Langone Medical Center, New York, NY.
authors.forename: Ezra
authors.initials: E
authors.lastname: Dweck
authors.affiliation: Division of General Internal Medicine and Clinical Innovation, Department of Medicine, NYU School of Medicine, NYU Langone Medical Center, New York, NY.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Iturrate
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D057286:Electronic Health Records / Q000706:statistics & numerical data; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006782:Hospitals, Special / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000453:epidemiology / Q000209:etiology*; D009518:New York / Q000453:epidemiology; D017063:Outcome Assessment, Health Care / Q000379:methods* / Q000706:statistics & numerical data; D059035:Perioperative Period / Q000706:statistics & numerical data; D011014:Pneumonia / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D011237:Predictive Value of Tests; D011655:Pulmonary Embolism / Q000150:complications / Q000453:epidemiology / Q000209:etiology*; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D013610:Tachycardia / Q000453:epidemiology / Q000209:etiology*; D014336:Troponin / Q000097:blood*; D014552:Urinary Tract Infections / Q000453:epidemiology
chemical_list: D014336:Troponin