Orthopedic Surgery and Cardiac Complications: Cutting the Risk

Researchers at Hospital for Special Surgery (HSS) report that the incidence of myocardial ischemia in patients with risk factors for cardiac events is high following major orthopedic surgery, although the frequency of serious cardiac complications remains low. The study authors recommend a blood test to measure troponin levels, an enzyme associated with cardiac complications, as a means to screen surgical candidates who are at risk for a cardiac event following their procedure. Lead author Michael Urban, MD, PhD, stated “We recommend measuring levels of a cardiac protein, troponin, which is released into the blood during cardiac injury. Identifying patients with elevated troponin levels allows us to intervene to prevent further cardiac events to improve outcome and reduce the overall cost of care.” The research was reported earlier this week in the HSS Journal.

In a 1-year period, HSS performed 1,627 major orthopedic procedures, including hip or knee replacements and spinal fusions. 805 were identified as at risk for postoperative myocardial ischemia, and 20% had elevated levels of troponin. Of these, 31% experienced postoperative cardiac complications. Spinal fusions were found to be associated with nearly 4 times greater risk for cardiac complications than were surgeries for joint replacement. Dr Urban noted “As demand for orthopedic surgery continues to rise, it is imperative that we identify more effective and efficient ways to reduce postsurgical complications.”

Read a news story about the findings and recommendations.

The journal article may be read here.