Evaluating the Risk of Cardiac Complications in Orthopaedic Surgery Patients with Heart Disease

    A study published in the HSS Journal shows a high incidence of myocardial ischemia, defined by an elevated troponin level, after major orthopedic surgery in patients with cardiac risk factors, although the incidence of serious cardiac complications remains low.

    Researchers from the Hospital for Special Surgery (HSS) recommend a simple blood test to measure troponin and help identify patients who are at greater risk of a cardiac event following surgery.

    Postoperative complications can be life-threatening and consume considerable healthcare resources. Orthopedic surgeries are on the rise, and by 2030, surgeons may be performing as many as 500,000 total hip replacements and 3 million total knee replacements per year.

    This study found that patients with higher postoperative levels of the enzyme troponin (cTnI) were more likely to have cardiac complications during hip or knee replacement surgery and spinal fusions. In addition, some procedures, such as spinal fusions, were found to place the patient at nearly 4 times greater risk compared to joint replacement procedures.

    During a 1-year period, 10,627 inpatient orthopedic procedures were performed at HSS, with 805 patients were identified as being at risk for postoperative myocardial ischemia. They found the following:

    • 7% of the at-risk orthopedic patients had postoperative troponin levels suggestive of myocardial injury, although approximately 20% had elevated troponin levels.
    • Of the patients with elevated troponin levels, 31% had postoperative cardiac complications.
    • Consistent with previously published research, nearly 90% of myocardial ischemic events occurred by the third day post-surgery.

    “As demand for orthopedic surgery continues to rise, it is imperative that we identify more effective and efficient ways to reduce post-surgical complications,” said lead author Dr. Michael K. Urban, MD, PhD, from the Division of Anesthesiology at HSS.

    “We believe measuring troponin levels in high-risk patients after orthopedic surgery can advance the management of patients with heart disease and reduce complications.”

    The American College of Cardiology and the American Heart Association also recommend measuring troponin levels for patients with signs or symptoms suggestive of myocardial ischemia.