Mitigating Myocardial Injury After Noncardiac Surgery in Orthopedic Surgery: Toward Improved Outcomes

Area of Science:

• Cardiology
• Orthopedic Surgery
• Perioperative Medicine

Background:

• Myocardial injury after noncardiac surgery (MINS) is an underreported cause of postoperative morbidity and mortality.
• MINS affects approximately 11.9% of orthopedic surgery patients, a population with unique risk factors.
• Current routine screening for MINS in orthopedic surgery remains rare despite its significant impact.

Purpose of the Study:

• To review the pathophysiology, epidemiology, risk assessment, prevention, and management of MINS in orthopedic surgery.
• To identify critical knowledge gaps in MINS care within orthopedic surgery.
• To propose strategies for mitigating MINS-related mortality and morbidity in orthopedic patients.

Main Methods:

• Narrative review of existing literature on MINS.
• Exploration of challenges specific to the orthopedic patient population.
• Discussion of potential strategies for improved MINS detection and management.

Main Results:

• MINS significantly contributes to postoperative morbidity and mortality in orthopedic surgery patients.
• Increasing age, comorbidities, and high-stress surgeries are key risk factors in this demographic.
• Lack of routine screening hinders timely diagnosis and intervention.

Conclusions:

• MINS is a critical concern in orthopedic surgery requiring greater attention.
• Routine screening, orthopedic-specific risk models, and novel therapies are needed.
• Addressing knowledge gaps can improve outcomes for orthopedic surgery patients experiencing MINS.