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Postoperative Tachycardia: Clinically Meaningful or Benign Consequence of Orthopedic Surgery?
Alana E Sigmund1, Yixin Fang2, Matthew Chin3
1Division of Perioperative Medicine, Hospital for Special Surgery, New York, NY.
Insights
Postoperative tachycardia, defined as a maximum heart rate over 110 beats/min, is a significant predictor of adverse vascular events after hip and knee arthroplasty. This finding highlights the clinical importance of monitoring heart rate in the early postoperative period.
Area of Science:
- Orthopedic Surgery
- Cardiovascular Medicine
- Critical Care Medicine
Background:
- Postoperative tachycardia is common after major orthopedic procedures.
- Its clinical significance and association with adverse outcomes remain incompletely understood.
Purpose of the Study:
- To determine the clinical significance of postoperative tachycardia.
- To identify an optimal definition of tachycardia predictive of adverse vascular events following hip and knee arthroplasty.
Main Methods:
- Retrospective analysis of two data sets (2011-2014) of patients undergoing hip and knee arthroplasty.
- Identified optimal tachycardia definition using a development data set.
- Assessed predictive value for pulmonary embolism, myocardial necrosis, and infection in a validation data set using logistic regression.
Main Results:
- A maximum heart rate >110 beats/min was the optimal definition for predicting vascular composite outcomes.
- This definition showed significant odds ratios for pulmonary embolism (OR 9.39) and myocardial necrosis (OR 4.71).
- High negative predictive value suggests tachycardia is a key indicator of potential complications.
Conclusions:
- Postoperative tachycardia within the first four days is not merely a variation in heart rate.
- It may precede serious adverse events such as pulmonary embolism and myocardial necrosis.
- Clinical vigilance for tachycardia is crucial in the early postoperative phase.
Objective:
To determine the clinical significance of tachycardia in the postoperative period.
Patients And Methods:
Individuals 18 years or older undergoing hip and knee arthroplasty were included in the study. Two data sets were collected from different time periods: development data set from January 1, 2011, through December 31, 2011, and validation data set from December 1, 2012, through September 1, 2014. We used the development data set to identify the optimal definition of tachycardia with the strongest association with the vascular composite outcome (pulmonary embolism and myocardial necrosis and infarction). The predictive value of this definition was assessed in the validation data set for each outcome of interest, pulmonary embolism, myocardial necrosis and infarction, and infection using multiple logistic regression to control for known risk factors.
Results:
In 1755 patients in the development data set, a maximum heart rate (HR) greater than 110 beats/min was found to be the best cutoff as a correlate of the composite vascular outcome. Of the 4621 patients who underwent arthroplasty in the validation data set, 40 (0.9%) had pulmonary embolism. The maximum HR greater than 110 beats/min had an odds ratio (OR) of 9.39 (95% CI, 4.67-18.87; sensitivity, 72.5%; specificity, 78.0%; positive predictive value, 2.8%; negative predictive value, 99.7%) for pulmonary embolism. Ninety-seven patients (2.1%) had myocardial necrosis (elevated troponin). The maximum HR greater than 110 beats/min had an OR of 4.71 (95% CI, 3.06-7.24; sensitivity, 47.4%; specificity, 78.1%; positive predictive value, 4.4%; negative predictive value, 98.6%) for this outcome. Thirteen (.3%) patients had myocardial infarction according to our predetermined definition, and the maximum HR greater than 110 beats/min had an OR of 1.72 (95% CI, 0.47-6.27).
Conclusion:
Postoperative tachycardia within the first 4 days of surgery should not be dismissed as a postoperative variation in HR, but may precede clinically significant adverse outcomes.
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