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In hip fracture surgery, elevated Troponin T level linked to morbidity and mortality
Investigators suggest screening Troponin T level in standard perioperative work-ups.
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A perioperative rise in the level of Troponin T, a cardiac enzyme, demonstrated a strong association with increased morbidity, mortality and hospital stay after femoral neck fracture surgery, according to British investigators.
Studies have found that cardiac enzymes, including Troponin T, can detect perioperative myocardial injury, which is a principal cause of early death after hip surgery, according to Sebastian J. Dawson-Bowling, MRCS.
In the first study to associate Troponin T levels to hip fractures, Dawson-Bowling and his co-authors found that 38.9% of study patients showed a perioperative Troponin T rise, and over half of these patients experienced a postoperative adverse event.
“Our study suggests that hip fracture patients with elevated Troponin T [levels] do have poorer clinical outcomes and longer stays in hospital, and many of these patients may be having silent cardiac-related events, which can contribute significantly to morbidity,” Dawson-Bowling said at the American Academy of Orthopaedic Surgeons 74th Annual Meeting.
He also presented the results at the 8th European Federation of National Associations of Orthopaedics and Traumatology Congress.
Complications and Troponin
Over a 4-month period, the investigators enrolled all patients over the age of 65 years who presented with a femoral neck fracture, while excluding any patients with renal failure, polymyositis and those previously treated conservatively. The final study enrollment included 108 patients.
The investigators measured patients’ Troponin T levels upon admission and at 1 day and 2 days after surgery.
Forty-two patients (38.9%) showed a rise in Troponin T levels greater than 0.03 ng/mL in at least one sample, Dawson-Bowling said. “These patients were ‘discussed’ with the on-call medical team, who then investigated and treated the patients as they deemed necessary.”
Based on clinical, electrocardiogram, radiological and echocardiographic parameters, the investigators found that 25 of the patients (59.5%) with a rise in perioperative Troponin T level sustained at least one complication or cardiorespiratory event, including myocardial infarction, congestive cardiac failure, unstable angina, major arrhythmias and pulmonary embolism.
Of the patients who did not show a rise in Troponin T levels, only seven patients (10.6%) sustained a complication, Dawson-Bowling said.
Further research necessary
Investigators also found nine deaths (21.4%) in the group of patients with raised Troponin T levels, and five deaths (7.6%) in the group without any rise in Troponin T levels.
Patients with a rise in Troponin T levels also stayed in the hospital for an average 1 week longer than the other patients, Dawson-Bowling said.
“This study has not attempted to demonstrate that measurement of Troponin actually improves the clinical outcome, and we also recognize that length of stay in hospital may be a poor indicator of medical morbidity,” Dawson-Bowling said.
He added: “We certainly feel that this is an area that merits further research, and we suggest that Troponin [level measurement] may ultimately form part of the standard perioperative work-up for patients presenting with femoral neck fractures.”
For more information:References:
- Sebastian J. Dawson-Bowling, MRCS, specialist registrar in the Southeast Thames orthopaedic rotation, can be reached at +44-127-320-5613; e-mail: sebd_b@hotmail.com. He has no financial conflicts to disclose.
- Dawson-Bowling SJ, Chettiar K, Cottam H, et al. Prognosis in fracture neck of femur – Does Troponin T predict morbidity and mortality? #F845. Presented at the 8th European Federation of National Associations of Orthopaedics and Traumatology Congress. May 11-15, 2007. Florence.
- Dawson-Bowling S, Chettiar K, Cottam H, et al. Troponin T as a predictive marker of morbidity in patients with fractured neck of femur. #227. Presented at the American Academy of Orthopaedic Surgeons 74th Annual Meeting. Feb. 14-18, 2007. San Diego.