Abstract 393: Perioperative Cardiovascular Events and Long-Term Mortality Following Orthopedic Surgery
Background: Adverse cardiovascular events are a major cause of morbidity and mortality in the perioperative period, however data on the association with long-term mortality are lacking. We therefore sought to investigate the long-term prognostic value of cardiovascular events and myocardial necrosis following orthopedic surgery.
Methods: We performed a long-term follow-up study of 3,082 consecutive subjects undergoing hip, knee, and spine surgery between November 1, 2008 and December 31, 2009. ICD-9 coding was used to ascertain patient characteristics. Perioperative complications of interest were myocardial necrosis (troponin level greater than the 99th percentile) and coded myocardial infarction (MI) as defined by ICD-9 coding. Social Security Death Index was used to assess mortality and date of death at a mean follow-up of 3.0 ± 0.5 years. A logistic regression model was used to identify independent predictors of long-term mortality.
Results: Of the 3,082 subjects, the mean age was 60.8 ± 13.3 years, 41% were male, and 65% were Caucasian. Myocardial infarction occurred in 20 (0.7%) subjects, and among 1062 with post-operatively troponin measured, myocardial necrosis occurred in 179 (16.9%) subjects. The overall incidence of death at a mean follow-up of 3.0 ± 0.5 years was 3.6%. Following multivariable logistic regression, baseline demographics associated with long-term mortality were increasing age (HR 1.04, 95% CI 1.02-1.05, P<0.0001), male sex (HR 1.53, 95% CI 1.04-2.24, P=0.03), emergent or urgent surgery (HR 4.46, 95% CI 2.84-6.99, P<0.0001), cancer (HR 16.61, 95% CI 10.52-26.24, P<0.0001), and diabetes (HR 1.62, 95% CI 1.03-2.54). Both myocardial necrosis (HR 1.84, 95% CI 1.11-3.04, P=0.02) and coded MI (HR 5.11, 95% CI 2.26-11.58, P<0.0001) were independent predictors of long-term mortality.
Conclusions: Perioperative troponin elevation and coded MI were independent predictors of long-term mortality. This raises the question of whether troponin should be routinely checked in the perioperative setting and whether treating patients found to have myocardial necrosis would attenuate the increased risk of long-term mortality.
Author Disclosures: B.S. Oberweis: None. S. Nukala: None. A. Rosenberg: None. Y. Guo: None. P. Olivieri: None. R. Bring: None. S. Stuchin: None. M.J. Radford: None. J.S. Berger: None.
- © 2014 by American Heart Association, Inc.