Nav: Home

Study finds cardiac complications high after orthopedic surgery for heart disease patients

July 31, 2017

A new study published today in the HSS Journal, the leading journal on musculoskeletal research, found the incidence of myocardial ischemia (defined by an elevated troponin level) after major orthopedic surgery in patients with cardiac risk factors is high, although the incidence of serious cardiac complications remains low. Hospital for Special Surgery (HSS) researchers recommend a simple blood test to measure troponin, an enzyme known to play a role in cardiac complications, to 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 there may be 500,000 total hip replacements and three million total knee replacements per year.

"Cardiovascular events are the most serious complications after major orthopedic surgeries, and patients with myocardial ischemia are at significant risk," said lead author Dr. Michael K. Urban, MD, PhD, Division of Anesthesiology, Hospital for Special Surgery. "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."

Plasma elevations in the enzyme troponin I (cTnI) are associated with myocardial events after major surgery and have been shown to be a more specific marker for cardiac injury compared to others. This study found that patients with higher postoperative cTnI levels 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 four times greater risk compared to joint replacement procedures.

Researchers concluded the incidence of postoperative myocardial ischemia (defined by elevated cTnI) after major orthopedic surgery in patients with cardiac risk factors is high (8.7%). During a one-year period, 10,627 inpatient orthopedic procedures were performed at HSS and 805 patients were identified as at risk for postoperative myocardial ischemia. Of the at-risk orthopedic patients, approximately 20 percent had elevated troponin levels, but less than 9 percent had troponin levels suggestive of myocardial injury. Of patients with elevated troponin levels, 31 percent had postoperative cardiac complications. Consistent with previously published research, nearly 90 percent 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 Dr. Urban. "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.
-end-
About Hospital for Special Surgery

Hospital for Special Surgery (HSS) is the world's leading academic medical center focused on musculoskeletal health. HSS is nationally ranked No. 1 in orthopedics and No. 2 in rheumatology by U.S. News & World Report (2016-2017), and is the first hospital in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center four consecutive times. HSS has one of the lowest infection rates in the country. HSS is an affiliate of Weill Cornell Medical College and as such all Hospital for Special Surgery medical staff are faculty of Weill Cornell. The hospital's research division is internationally recognized as a leader in the investigation of musculoskeletal and autoimmune diseases. HSS has locations in New York, New Jersey and Connecticut. http://www.hss.edu.

About HSS Journal

HSS Journal®, The Musculoskeletal Journal of Hospital for Special Surgery, is the leading journal on musculoskeletal cutting edge research, clinical pathways, treatment, and state-of-the-art techniques. Original, peer-reviewed research and review articles educate the community across a wide spectrum of musculoskeletal diseases and conditions such as anesthesia, peri-operative medicine, basic science of bone and mineral medicine, radiology, imaging, pathology, rheumatology, neurology, psychiatry and rehabilitation.

Contact Information

Tracy Hickenbottom
Monique Irons
Sherry Randolph
212.606.1197
mediarelations@hss.edu

Hospital for Special Surgery

Related Surgery Articles:

Bullies and their victims more likely to want plastic surgery
11.5 percent of bullying victims have extreme desire to have cosmetic surgery, as well as 3.4 percent of bullies and 8.8 percent of teenagers who both bully and are bullied -- compared with less than 1 percent of those who are unaffected by bullying.
Methadone may reduce need for opioids after surgery
Patients undergoing spinal fusion surgery who are treated with methadone during the procedure require significantly less intravenous and oral opioids to manage postoperative pain, reports a new study published in the May issue of Anesthesiology, the peer-reviewed medical journal of the American Society of Anesthesiologists (ASA).
New, persistent opioid use common after surgery
Among about 36,000 patients, approximately 6 percent continued to use opioids more than three months after their surgery, with rates not differing between major and minor surgical procedures, according to a study published by JAMA Surgery.
Refusing access to surgery recovery area at a UK hospital unless WHO Safe Surgery Checklist is fully complete
New research showing that refusal to allow surgery teams to take the patient to the recovery room after surgery unless the full WHO Safe Surgery Checklist has been complete is a highly effective way to improve use of the checklist.
Robotic surgery just got more autonomous
Putting surgery one step closer into the realm of self-driving cars and intelligent machines, researchers show for the first time that a supervised autonomous robot can successfully perform soft tissue surgery.
More Surgery News and Surgery Current Events

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Teaching For Better Humans
More than test scores or good grades — what do kids need to prepare them for the future? This hour, guest host Manoush Zomorodi and TED speakers explore how to help children grow into better humans, in and out of the classroom. Guests include educators Olympia Della Flora and Liz Kleinrock, psychologist Thomas Curran, and writer Jacqueline Woodson.
Now Playing: Science for the People

#535 Superior
Apologies for the delay getting this week's episode out! A technical glitch slowed us down, but all is once again well. This week, we look at the often troubling intertwining of science and race: its long history, its ability to persist even during periods of disrepute, and the current forms it takes as it resurfaces, leveraging the internet and nationalism to buoy itself. We speak with Angela Saini, independent journalist and author of the new book "Superior: The Return of Race Science", about where race science went and how it's coming back.