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High rate of myocardial ischemia found after orthopedic surgery in at-risk patients
Investigators of this study found 8.7% of patients at-risk for postoperative cardiac complications had evidence of myocardial injury following orthopedic surgery. However, investigators of the study wrote, “the incidence of documented myocardial infarctions and serious cardiac complications remains low (1.2% to 2%).”
During a 1-year period, researchers identified patients with a measured cTnI level using an electronic ordering system that were scheduled to undergo total of 10,627 inpatient orthopedic procedures, including total knee arthroplasty (TKA), total hip arthroplasty (THA) and posterior spinal fusion (PSF). Investigators evaluated patients for preoperative cardiac risk factors and postoperative cardiac complications. They used new echocardiographic regional wall motion abnormalities, ECG changes, evaluation by a cardiologist and cTnI of greater than 0.1 ng/mL to define postoperative myocardial infarction.
Results showed 805 patients were at risk of developing postoperative myocardial ischemia. Of these patients, 20.6% had elevated levels of serum cTnI. Investigators recorded cases 10 postoperative myocardial ischemia. Elevated cTnI levels were seen in 19% of at-risk patients who underwent TKA, THA or PSF and 31% developed postoperative complications, which included arrhythmias, congestive heart failure and myocardial ischemia.
Patients who underwent PSF had a 3.9-times greater chance of myocardial injury compared with patients who underwent TKA and had a 4.2-times greater chance of having this injury compared with patients who underwent THA.
“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,” investigators wrote. – by Monica Jaramillo
Disclosure: The study was funded by the Quality Research Division of Hospital for Special Surgery.