Age and Ageing Advance Access published online on November 13, 2008
Age and Ageing, doi:10.1093/ageing/afn231
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Incidence of post-operative troponin I rises and 1-year mortality after emergency orthopaedic surgery in older patients
1 Department of Aged Care, The Northern Hospital, Epping, Victoria, Australia
2 Northern Clinical Research Centre, Northern Health and Department of Medicine, The University of Melbourne, Victoria, Australia
3 Department of Biochemistry, The Northern Hospital, Epping, Victoria, Australia
Address correspondence to: Dr C. P. Chong. Tel: (+61) 11 613 8405 2008; Fax: (+61) 11 613 8405 8683; Email: carol.chong{at}nh.org.au; or Dr W. K. Lim. Tel: (+61) 11 613 8405 2017; Fax: (+61) 11 613 8405 8479; Email: kwang.lim{at}nh.org.au
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, post-operative 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.
Keywords: troponin I, orthopaedic surgery, aged, mortality, cardiac outcome, fracture
Received 3 April 2008; accepted in revised form 7 July 2008.
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