The Incidence of Perioperative Cardiac Events after Orthopedic Surgery: A Single Institutional Experience of Cases Performed over One Year

Abstract

BackgroundOrthopedic patients with ischemic heart disease are at risk for postoperative cardiac complications.Questions/PurposesUsing information from two medical information retrieval systems which insured the capture of all events for the period of study, our goals were to determine the incidence of myocardial injury in at-risk patients after orthopedic surgery and to delineate the type and incidence of cardiac complications in this population.MethodsFor one year, at an orthopedic hospital, we identified all postoperative patients with a measured cTnI level using an electronic ordering system. Preoperative cardiac risk factors and postoperative cardiac complications were identified in patients undergoing a total hip arthroplasty (THA), total knee arthroplasty (TKA), and posterior spinal fusion (PSF). A postoperative myocardial infarction was defined by a cTnI > 0.1 ng/mL, ECG changes, new echocardiographic regional wall motion abnormalities, and evaluation by a cardiologist. Categorical variables were compared among groups with a Fisher’s exact or Chi-square test. Continuous variables were compared among groups with ANOVA or the Kruskal-Wallis test. The associations of cardiac risk factors with myocardial injury are expressed as odds ratios from logistic regression models.ResultsDuring a one-year period, from 10,627 inpatient orthopedic procedures, 805 patients were identified as at risk for postoperative myocardial ischemia. A total of 20.6% (166/805) of these patients had elevated serum cTnI levels (cTnI > 0.02 ng/mL), and there were ten documented postoperative MIs (10/805; 1.2%). For the at-risk TKA, THA, or PSF patients, 19% (102/532) had elevated cTnI levels and 31% (32/102) had postoperative cardiac complications, including arrhythmias (56%), congestive heart failure (2%), and MI (1%). Adjusting for sex, age, BMI, cardiac risk factors, and medications (statins and β-blockers), PSF patients had 3.9 times the risk of myocardial injury (p = 0.003) compared to TKA patients and 4.2 times that of THA patients.ConclusionsThe incidence of postoperative myocardial ischemia after major orthopedic surgery in patients with cardiac risk factors is high (8.7%), but the incidence of documented myocardial infarctions and serious cardiac complications remains low (1.2–2%). Patients with higher postoperative cTnI releases were more likely to have cardiac complications, and some procedures (spinal fusions) placed the patients at a higher risk.Electronic supplementary materialThe online version of this article (doi:10.1007/s11420-017-9561-9) contains supplementary material, which is available to authorized users.

Myocardial infarction following fast-track total hip and knee arthroplasty—incidence, time course, and risk factors: a prospective cohort study of 24,862 procedures

“…2015, Urban et al. 2017); however, we were unable to demonstrate any significant association between age and MI until age >85 years. That IDDM, cardiovascular disease, and hypercholesterolemia were found to be associated with MI in our study is unsurprising as these are well-known risk factors (Mantilla et al.…”

“…2017, Urban et al. 2017). Although, the numbers we found are comparable to previous fast-track THA and TKA studies (Malviya et al.…”

“…2017, Urban et al. 2017). These databases lack detailed information on perioperative care, which limits the ability to identify potential pathophysiological events leading to MI.…”

Characteristics and long-term mortality of patients with ST-elevation or non-ST-elevation myocardial infarction after orthopaedic surgery

“…14–16 Another study reported a postoperative MI incidence of 1.2% in patients with cardiac risk factors and 0.09% in all patients undergoing major orthopaedic surgery. 17 This was slightly lower than the incidence of 0.5% for a perioperative MI in the current study. In this study, a value of troponin I ≥ 0.1 μg/l (five-times the reference levels) was used to diagnose MI, which may have underestimated the incidence of MI.…”

Perioperative Cardiac Troponin I Levels in Patients Undergoing Total Hip and Total Knee Arthroplasty: A Single Center Study

“…A recent single-center study (26) of the cardiac event in patients undergoing THA, TKA, and posterior spinal fusion showed that 20.6% of patients at risk of postoperative cardiac ischemia had elevated cTnI levels; 8.7% of patients had a myocardial injury and 1.2% of these patients (10/805) had a postoperative MI. Although this study just evaluated the patients at risk of postoperative myocardial ischemia, the significant troponin elevation confirms our findings of the postoperative elevation of cardiac troponin.…”