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

Myocardial injury after noncardiac surgery (MINS) is a relatively new and underreported diagnosis that significantly contributes to postoperative morbidity and mortality. MINS is defined by elevated cardiac troponin levels postoperatively, with or without symptoms, and affects approximately 11.9% of orthopedic surgery patients. The orthopedic patient population presents unique challenges related to MINS due to patient demographics such as increasing age, comorbidities, and high physiological stress surgeries. Despite the significant impact of MINS on short- and long-term mortality, routine screening in orthopedic surgery and surgery in general remains rare. In this narrative review, we explore the pathophysiology, epidemiology, risk assessment, prevention, and management of MINS in the context of orthopedic surgery. We aim to highlight critical knowledge gaps and propose strategies to address these gaps, including the role of routine screening, novel therapeutic approaches, and the development of orthopedic-specific risk models. In doing so, we hope to mitigate the mortality and morbidity associated with MINS and improve outcomes for orthopedic surgery patients.