New York, NY—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.1
"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, Department 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.
About HSS | Hospital for Special Surgery
HSS is the world’s leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the eighth consecutive year) and No. 3 in rheumatology by U.S. News & World Report (2017-2018). Founded in 1863, the Hospital has one of the lowest infection rates in the country and was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center four consecutive times. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State. In 2017 HSS provided care to 135,000 patients from 80 countries and performed more than 32,000 surgical procedures. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. The HSS Innovation Institute was formed in 2015 to realize the potential of new drugs, therapeutics and devices; the global standard total knee replacement was developed at HSS in 1969, and in 2017 HSS made 130 invention submissions (more than 2x the submissions in 2015). The HSS Education Institute provides continuing medical curriculum to more than 22,000 subscribing musculoskeletal healthcare professionals in 125 countries. Through HSS Global, the institution is collaborating with medical centers worldwide to advance the quality and value of care and to make world-class HSS care more accessible to more people.