Does cardiology intervention improve mortality for post-operative troponin elevations after emergency orthopaedic–geriatric surgery? A randomised controlled study

• Published in: Injury Vol. 43; no. 7; pp. 1193 - 1198
• Main Authors: Chong, Carol P, van Gaal, William J, Ryan, Julie E, Profitis, Konstantinos, Savige, Judy, Lim, Wen Kwang
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.07.2012
• Subjects: Aged, 80 and over; Australia - epidemiology; Cardiovascular; Comorbidity; Emergency Medical Services; Female; Fractures; Fractures, Bone - blood; Fractures, Bone - mortality; Fractures, Bone - surgery; Heart Diseases - blood; Heart Diseases - mortality; Heart Diseases - surgery; Humans; Male; Mortality; Orthopaedic surgery; Orthopedic Procedures - mortality; Orthopedics; Postoperative Complications - blood; Postoperative Complications - mortality; Postoperative Complications - surgery; Postoperative Period; Predictive Value of Tests; Prognosis; Risk Factors; Treatment Outcome; Troponin; Troponin I - blood; Australia; Troponin; Fractures; Cardiovascular; Mortality; Orthopaedic surgery
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/j.injury.2012.03.034

Abstract Objectives Troponin elevations are common after emergency orthopaedic surgery and confer a higher mortality at one year. The objective was to determine if comprehensive cardiology care after emergency orthopaedic surgery reduces mortality at one year in patients who sustain a post-operative troponin elevation versus standard care. Methods A randomised controlled trial was conducted at a metropolitan teaching hospital in Melbourne, Australia. 187 consecutive patients were eligible with 70 patients randomised. Troponin I was tested peri-operatively and patients with a troponin elevation were randomised to cardiology care versus standard ward management. The main outcome measure was one year mortality. Results The incidence of a post-operative troponin elevation was 37.4% (70/187) and these 70 patients were randomised. In-hospital cardiac complications were similar between the randomised groups: standard care (7/35 or 20.0%) versus cardiology care (8/35 or 22.9%). There was no difference in 1 year mortality between the randomised groups (6/35 or 17.1% in each group). Multivariate predictors of 1 year mortality were post-operative troponin elevation OR 4.3 (95% CI, 1.1–16.4, p = 0.035), age OR 1.1 (95% CI, 1.02–1.2, p = 0.016) and number of comorbidities OR 2.1 (95% CI, 1.3–3.5, p = 0.004). At 1 year 35/187 (18.7%) sustained a cardiac complication and 23/35 (65.7%) had a troponin elevation. Conclusions There was no difference in mortality between patients with a post-operative troponin elevation randomised to cardiology care compared with standard care. Troponin elevation predicted one year mortality. Further research is needed to find an effective intervention to reduce mortality.