by Elizabeth Hofheinz, M.P.H., M.Ed.
In the largest ever prospective study on cardiac outcomes after orthopedic surgery, researchers from multiple centers around the globe have determined that sometimes fatal myocardial injury after noncardiac surgery (MINS) events are quite common after orthopedic surgery.
Their work, “Association Between Myocardial Injury and Cardiovascular Outcomes of Orthopaedic Surgery,” appears in the May 20, 2020 edition of The Journal of Bone and Joint Surgery.
Co-author Sabu Thomas M.D. is Associate Professor in the Division of Cardiology at the University of Rochester School of Medicine. He told OSN, “Globally there are more than 200 million adults who undergo major noncardiac surgery annually. Despite benefits associated with surgery, major perioperative complications, including death, occur. More than 1 million adults worldwide will die within 30 days of their surgery each year. The majority of these events are cardiac in nature. When patients have surgery, they are vulnerable to have important events missed because the pain medications patients take can mask symptoms of complications (e.g., narcotics can mask chest pain due to a heart attack or injury).”
“Because of this possibility, we undertook a study measuring a simple blood marker (i.e., troponin) that identifies heart injury to determine if prognostically important heart injuries were occurring after orthopedic surgery that would go unrecognized with measurement of this simple blood test, troponin. An elevated troponin measurement after surgery that physicians judge as due to an ischemic cause is known as MINS. MINS is strongly correlated with an increased risk of dying in 30 days.”
Providing details on their work, Dr. Thomas commented to OSN, “This was a pre-specified analysis of the VISION study where we looked at more than 15,000 patients who were undergoing non-cardiac surgery. More than 3,000 of these patients underwent an orthopedic procedure. Troponins were checked on post op days 0, 1, 2 and 3. 11.9% had an elevated troponin after surgery, which met the criteria for MINS. The 30-day mortality for those with MINS was 9.8% (about 1 in 8 patients died) compared to 1% in those without MINS. More than 80% of these cases were asymptomatic and would have normally gone undetected had it not been for routine troponin monitoring.”
“This study exposes how common MINS events are after orthopedic surgery, the increased risk of death with MINS, and how the vast majority of MINS events will go undetected without measuring troponins after surgery. There are treatment options for MINS including aspirin, statins, and anticoagulants. This study highlights the relevance and importance of measuring troponins in patients after orthopedic surgery.”