Cardiac injury and troponin testing after orthopaedic surgery
Carol P Chong1, William J van Gaal, Judy Savige
1The Northern Clinical Research Centre, The Northern Hospital, Epping, Victoria, Australia. carol.chong@nh.org.au
Insights
Cardiac injury is a growing concern following orthopaedic surgery. Troponin testing effectively detects this injury, even in asymptomatic patients, who face higher risks of complications and mortality.
Area of Science:
- Cardiology
- Orthopaedic Surgery
- Biomarkers
Background:
- Cardiac injury is an increasing concern in patients undergoing orthopaedic surgery, particularly the elderly.
- Cardiac troponins aid in detecting myocardial injury, but their role post-orthopaedic surgery requires clarification.
Purpose of the Study:
- To review the diagnosis and pathophysiology of myocardial infarction after orthopaedic surgery.
- To examine myocardial injury detection methods, focusing on troponin testing.
Main Methods:
- A literature review of eight recent orthopaedic trials evaluating troponin use was conducted.
Main Results:
- Diagnosing myocardial infarction post-orthopaedic surgery is challenging due to atypical symptoms; troponin rise and fall are key indicators.
- Ischaemia pathophysiology may differ in the post-orthopaedic surgery setting.
- Troponin elevation occurs in 22-52.9% of emergency orthopaedic operations, often asymptomatically, and predicts adverse outcomes.
Conclusions:
- Cardiac injury is a significant complication of orthopaedic surgery.
- Troponin testing identifies asymptomatic cardiac injury, indicating patients at risk for poorer outcomes.
- Future research should focus on therapeutic strategies for these high-risk patients.
Background:
Cardiac injury after orthopaedic surgery is an increasing problem particularly in an ageing population. The detection of cardiac injury has been aided by the use of cardiac troponins which has also raised questions about the utility of this enzyme in the post-operative setting.
Objective:
This review evaluates the diagnosis and pathophysiology of myocardial infarction after orthopaedic surgery and examines how myocardial injury is detected, with particular emphasis on the role of troponin testing.
Subjects:
Eight recent orthopaedic trials evaluating the use of troponin were identified in the literature and included in this review.
Results:
This review found that the diagnosis of myocardial infarction ismore difficult after surgery since classic symptoms may be atypical or absent. Therefore, there ismore reliance on the typical rise and fall in troponin to diagnose cardiac injury especially because electrocardiograph changes may be hard to detect. The pathophysiology of ischaemia after orthopaedic surgery may be different to ischaemia in the non-surgical setting. The incidence of troponin elevation is between 22 and 52.9% after emergency orthopaedic operations. Of note, patients sustaining a troponin elevation are often asymptomatic. Small studies have found troponin to be a prognostic marker of in-hospital cardiac complications, increased length of stay, increased likelihood of discharge to residential care and death at 1 year. No interventional studies have been published to date.
Conclusion:
Cardiac injury is an important complication after orthopaedic surgery. Studies have found that troponin testing can detect asymptomatic cardiac injury. These patients are at risk of poorer outcomes and future research should be directed towards treatment of these patients.
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