Incidence of post-operative troponin I rises and 1-year mortality after emergency orthopaedic surgery in older patients
| Autor: | Julie E. Ryan, Rabindra N. Sinnappu, Carol P Chong, Wen Kwang Lim, Que T. Lam |
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| Rok vydání: | 2008 |
| Předmět: |
Male
Emergency Medical Services Aging medicine.medical_specialty Multivariate analysis Heart Diseases Fractures Bone Postoperative Complications Predictive Value of Tests Risk Factors Internal medicine Outpatients Troponin I medicine Humans Orthopedic Procedures Myocardial infarction Aged Aged 80 and over Inpatients biology business.industry Incidence Incidence (epidemiology) Atrial fibrillation General Medicine Middle Aged medicine.disease Troponin Predictive value of tests Orthopedic surgery Cardiology biology.protein Female Geriatrics and Gerontology business |
| Zdroj: | Age and Ageing. 38:168-174 |
| ISSN: | 1468-2834 0002-0729 |
| DOI: | 10.1093/ageing/afn231 |
| Popis: | Objectives: to determine the incidence of post-operative troponin I rises and its association with 1-year all-cause mortality and cardiac events after emergency orthopaedic-geriatric surgery, which has not been studied before. Methods: one hundred and two patients over the age of 60 were recruited and followed up at 1 year. All consented to serial troponin I measurements peri-operatively. Results: the incidence of a troponin I rise post-operatively was 52.9%. Post-operative acute myocardial infarction was diagnosed in 9.8% and at 1 year, 70% of these patients were dead. At 1 year, 32.4% (33/102) had sustained a cardiac event (myocardial infarction, congestive cardiac failure, atrial fibrillation or major arrhythmia) and using multivariate analysis, postoperative troponin rise (OR 3.9, 95% CI 1.4‐10.7, P = 0.008) was an independent predictor of this. Half of the patients with a troponin rise had a cardiac event compared to 18.8% without a rise. All-cause mortality was 20.6% at 1 year; 37% with an associated post-operative troponin rise died versus 2.1% without a rise (P < 0.0001). Using multivariate analysis, only two factors were associated with 1-year all-cause mortality: post-operative troponin rise (OR 12.0, 95% CI 1.4‐104.8, P = 0.025) and sustaining a post-operative in-hospital cardiac event (OR 6.6, 95% CI 1.7‐25.6, P = 0.006). Furthermore, patients with higher troponin levels had significantly worse survival. Conclusions: there is a high incidence of post-operative troponin I rises in older patients undergoing emergency orthopaedic surgery with 1-year mortality and cardiac events being significantly increased in these patients. Future studies are needed to determine whether any intervention can improve outcome for these patients. |
| Databáze: | OpenAIRE |
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