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

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• 作者：Carol P. Chong^a ; ^d ; ^e ; ^{carol.chong@nh.org.au} ; William J. van Gaal^c ; ^e ; Julie E. Ryan^b ; Konstantinos Profitis^c ; Judy Savige^d ; ^e ; Wen Kwang Lim^a ; ^d ; ^e ; ^{kwang.lim@nh.org.au}
• 关键词：Troponin ; Mortality ; Orthopaedic surgery ; Fractures ; Cardiovascular
• 刊名：Injury
• 出版年：2012
• 期刊代码：120_00201383
• 类别：med
• 出版时间：July, 2012
• 卷：43
• 期：7
• 页码：1193-1198
• 文件大小：501 K

摘要

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.