Home E-Weekly August 8, 2017

Limit Cardiac Concerns Following Orthopedic Procedures

Published: August 7, 2017

HEART PROBLEM Spinal fusion patients were nearly 4 times more likely than joint replacement patients to suffer cardiac complications.

Patients with heart disease who undergo orthopedic procedures are at increased risk of myocardial ischemia, but new research says a simple blood test can identify individuals who are most likely to suffer post-op cardiac complications.

Elevated plasma levels in the enzyme troponin is an indicator of myocardial events and cardiac injury after major surgery, according to investigators at the Hospital for Special Surgery in New York City. They say 20% of the 805 patients who underwent hip or knee replacements and spinal fusions and who were identified at increased risk of post-op myocardial ischemia had elevated levels of troponin. One-third of the at-risk patients suffered post-op cardiac complications, according to the study. Additionally, say the researchers, nearly all of the myocardial ischemic events occurred within 3 days of surgery.

Cardiovascular events are the most serious complications after major orthopedic surgeries and patients with myocardial ischemia are at significant risk, according to study lead author Michael Urban, MD, PhD, of the division of anesthesiology at the Hospital for Special Surgery. He says identifying patients with elevated troponin levels before surgery lets providers intervene to prevent cardiac complications after surgery.

The researchers point out that by 2030 an estimated 500,000 total hips and 3 million total knees will be performed annually. "As demand for orthopedic surgery continues to rise, it is imperative that we identify more effective and efficient ways to reduce post-surgical complications," adds 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."

Daniel Cook

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