scholarly journals Perioperative Myocardial Infarction/Myocardial Injury Is Associated with High Hospital Mortality in Elderly Patients Undergoing Hip Fracture Surgery

2020 ◽  
Vol 9 (12) ◽  
pp. 4043
Author(s):  
Carlo Rostagno ◽  
Alessandro Cartei ◽  
Gaia Rubbieri ◽  
Alice Ceccofiglio ◽  
Agnese Magni ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Hip Fracture ◽  
Hospital Mortality ◽  
Myocardial Injury ◽  
Troponin I ◽  
Cardiovascular Complications ◽  
Elevated Troponin ◽  
Hip Fracture Surgery ◽  
Hospital Stays ◽  
Fracture Surgery

Cardiovascular complications in patients undergoing non-cardiac surgery are associated with longer hospital stays and higher in-hospital mortality. The aim of this study was to assess the incidence of in-hospital myocardial infarction and/or myocardial injury in patients undergoing hip fracture surgery and their association with mortality. Moreover, we evaluated the prognostic value of troponin increase stratified on the basis of peak troponin value. The electronic records of 1970 consecutive hip fracture patients were reviewed. Patients <70 years, those with myocardial infarction <30 days, and those with sepsis or active cancer were excluded from the study. Troponin and ECG were obtained at admission and then at 12, 24, and 48 h after surgery. Echocardiography was made before and within 48 h after surgery. Myocardial injury was defined by peak troponin I levels > 99th percentile. A total of 1854 patients were included. An elevated troponin concentration was observed in 754 (40.7%) patients in the study population. Evidence of myocardial ischemia, fulfilling diagnosis of myocardial infarction, was found in 433 (57%). ECG and echo abnormalities were more frequent in patients with higher troponin values; however, mortality did not differ between patients with and without evidence of ischemia. Peak troponin was between 0.1 and 1 µg/L in 593 (30.3%). A total of 191 (10%) had peak troponin I ≥ 1 µg/L, and 98 died in hospital (5%). Mortality was significantly higher in both groups with troponin increase (HR = 1.37, 95% CI 1.1–1.7, p < 0.001 for peak troponin I between 0.1 and 1 µg/L; HR = 2.28, 95% CI 1.72–3.02, p < 0.0001 for peak troponin ≥1 µg/L) in comparison to patients without myocardial injury. Male gender, history of coronary heart disease, heart failure, and chronic kidney disease were also associated with in-hospital mortality. Myocardial injury/infarction is associated with increased mortality after hip fracture surgery. Elevated troponin values, but not ischemic changes, are related to early worse outcome.

scholarly journals The effect of remote ischaemic preconditioning on myocardial injury in emergency hip fracture surgery (PIXIE trial): phase II randomised clinical trial

BMJ ◽  
2019 ◽  
pp. l6395 ◽  
Author(s):  
Sarah Ekeloef ◽  
Morten Homilius ◽  
Maiken Stilling ◽  
Peter Ekeloef ◽  
Seda Koyuncu ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Myocardial Injury ◽  
Primary Outcome ◽  
Troponin I ◽  
Peak Plasma ◽  
Major Adverse Cardiovascular Events ◽  
Control Group ◽  
Hip Fracture Surgery ◽  
Secondary Outcomes ◽  
Fracture Surgery

Abstract Objective To investigate whether remote ischaemic preconditioning (RIPC) prevents myocardial injury in patients undergoing hip fracture surgery. Design Phase II, multicentre, randomised, observer blinded, clinical trial. Setting Three Danish university hospitals, 2015-17. Participants 648 patients with cardiovascular risk factors undergoing hip fracture surgery. 286 patients were assigned to RIPC and 287 were assigned to standard practice (control group). Intervention The RIPC procedure was initiated before surgery with a tourniquet applied to the upper arm and consisted of four cycles of forearm ischaemia for five minutes followed by reperfusion for five minutes. Main outcome measures The original primary outcome was myocardial injury within four days of surgery, defined as a peak plasma cardiac troponin I concentration of 45 ng/L or more caused by ischaemia. The revised primary outcome was myocardial injury within four days of surgery, defined as a peak plasma cardiac troponin I concentration of 45 ng/L or more or high sensitive troponin I greater than 24 ng/L (the primary outcome was changed owing to availability of testing). Secondary outcomes were peak plasma troponin I and total troponin I release during the first four days after surgery (cardiac and high sensitive troponin I), perioperative myocardial infarction, major adverse cardiovascular events, and all cause mortality within 30 days of surgery, length of postoperative stay, and length of stay in the intensive care unit. Several planned secondary outcomes will be reported elsewhere. Results 573 of the 648 randomised patients were included in the intention-to-treat analysis (mean age 79 (SD 10) years; 399 (70%) women). The primary outcome occurred in 25 of 168 (15%) patients in the RIPC group and 45 of 158 (28%) in the control group (odds ratio 0.44, 95% confidence interval 0.25 to 0.76; P=0.003). The revised primary outcome occurred in 57 of 286 patients (20%) in the RIPC group and 90 of 287 (31%) in the control group (0.55, 0.37 to 0.80; P=0.002). Myocardial infarction occurred in 10 patients (3%) in the RIPC group and 21 patients (7%) in the control group (0.46, 0.21 to 0.99; P=0.04). Statistical power was insufficient to draw firm conclusions on differences between groups for the other clinical secondary outcomes (major adverse cardiovascular events, 30 day all cause mortality, length of postoperative stay, and length of stay in the intensive care unit). Conclusions RIPC reduced the risk of myocardial injury and infarction after emergency hip fracture surgery. It cannot be concluded that RIPC overall prevents major adverse cardiovascular events after surgery. The findings support larger scale clinical trials to assess longer term clinical outcomes and mortality. Trial registration ClinicalTrials.gov NCT02344797 .

Prediction Model of In-Hospital Mortality After Hip Fracture Surgery

2018 ◽  
Vol 32 (1) ◽  
pp. 34-38 ◽  
Author(s):  
Atsushi Endo ◽  
Heather J. Baer ◽  
Masashi Nagao ◽  
Michael J. Weaver
Keyword(s):  
Hip Fracture ◽  
Hospital Mortality ◽  
Prediction Model ◽  
Hip Fracture Surgery ◽  
Fracture Surgery

scholarly journals Hospital mortality after hip fracture surgery in relation to length of stay by care delivery factors

Medicine ◽  
2017 ◽  
Vol 96 (16) ◽  
pp. e6683 ◽  
Author(s):  
Boris Sobolev ◽  
Pierre Guy ◽  
Katie J. Sheehan ◽  
Eric Bohm ◽  
Lauren Beaupre ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Care Delivery ◽  
Hip Fracture Surgery ◽  
Fracture Surgery

Preoperative cardiac risk factors associated with in-hospital mortality in elderly patients without heart failure undergoing hip fracture surgery: a single-centre study

2020 ◽  
pp. postgradmedj-2020-138679
Author(s):  
Vedat Çiçek ◽  
Tufan Cinar ◽  
Mert Ilker Hayiroglu ◽  
Şahhan Kılıç ◽  
Nürgül Keser ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Hip Fracture ◽  
Elderly Patients ◽  
Hospital Mortality ◽  
Cardiac Risk ◽  
Cardiac Risk Factors ◽  
Hip Fracture Surgery ◽  
Single Centre Study ◽  
Fracture Surgery

IntroductionIn the present study, our aim was to ascertain the preoperative cardiac risk factors related to the in-hospital mortality in the elderly patients (aged over 65 years) who required preoperative cardiology consultation for hip fracture surgery.Material and MethodsThe present study was a retrospective, single-centre study, which enrolled consecutive elderly patients without heart failure scheduled for hip fracture surgery in our institution. In all patients, an anesthesiologist performed a detailed preoperative evaluation and decided the need for the cardiac consultation. Patients underwent preoperative cardiac evaluation by a trained cardiologist using the algorithms proposed in the recent preoperative guidelines. The in-hospital mortality was the main outcome of the study.ResultsIn total, 277 elderly patients undergoing hip fracture surgery were enrolled in this analysis. The overall in-hospital mortality rate was 12.1% (n=30 cases). In a multivariate analysis, we found that insulin dependency, cancer, urea, presence of atrial fibrillation (AF) (OR: 3.906; 95% CI 1.470 to 10.381; p=0.006) and pulmonary artery systolic pressure (PASP) (OR: 1.057; 95% CI 1.016 to 1.100; p=0.006) were the predictors of in-hospital mortality. The receiver operating characteristic curve analysis revealed that the optimal value of PASP in predicting the in-hospital mortality was 35 mm Hg (area under the curve=0.71; 95% CI 0.60 to 0.81, p<0.001) with sensitivity of 87.7% and specificity of 59.5%.ConclusionThe present research found that the preoperative cardiac risk factors, namely AF and PASP, might be associated with increased in-hospital mortality in elderly patients without heart failure undergoing hip fracture surgery.

scholarly journals RISK FACTORS FOR LONG-TERM MORTALITY IN VERY ELDERLY AFTER POST-OPERATIVE MYOCARDIAL INFARCTION FOLLOWING HIP FRACTURE SURGERY

2011 ◽  
Vol 57 (14) ◽  
pp. E1038 ◽  
Author(s):  
Bhanu P. Gupta ◽  
Lisa L. Kirkland ◽  
Jeanne M. Huddleston ◽  
Paul M. Huddleston ◽  
M Caroline Burton ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Hip Fracture ◽  
Very Elderly ◽  
Hip Fracture Surgery ◽  
Fracture Surgery ◽  
Long Term Mortality

scholarly journals Topical tranexamic acid in hip fractures: a randomized, placebo-controlled double-blinded study

2021 ◽  
Vol 64 (4) ◽  
pp. E449-E456
Author(s):  
Darren Costain ◽  
Graham Elder ◽  
Brian Fraser ◽  
Brad Slagel ◽  
Adrienne Kelly ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Troponin I ◽  
Postoperative Blood Loss ◽  
Control Group ◽  
Hip Fracture Surgery ◽  
Coronary Syndrome ◽  
The Difference ◽  
Fracture Surgery

Background: Tranexamic acid (TXA) has been shown to reduce perioperative blood loss in elective orthopedic surgery. The safety of intravenous TXA in nonelective hip fracture surgery is uncertain. The purpose of this study was to evaluate the efficacy and safety of topical TXA in hip fracture surgery. Methods: Adult patients presenting to a community hospital with a hip fracture requiring surgery were randomly assigned to receive topical TXA or placebo. Hemoglobin and troponin I levels were measured preoperatively and on postoperative days 1, 2 and 3. All postoperative blood transfusions were recorded. Complications, including acute coronary syndrome (ACS), venous thromboembolism (VTE), cerebrovascular accidents (CVA), surgical site infections (SSI) and 90-day mortality, were recorded. Results: Data were analyzed for 65 patients (31 in the TXA group, 34 in the control group). Hemogloblin level was significantly higher on postoperative days 1 and 2 in the TXA group than in the control group. The difference in hemoglobin level between the groups was not statistically significant by postoperative day 3. Significantly fewer units of packed red blood cells were transfused in the TXA group (2 units v. 8 units); however, 2 of the units in the control group were given intraoperatively, and when these were excluded the difference was not significant. The incidence of ACS, CVA, VTE, SSI, transfusion and all-cause mortality at 90 days did not differ significantly between the groups. Conclusion: Topical TXA reduces early postoperative blood loss after hip fracture surgery without increased patient risk. Trial registration: Clinicaltrials.gov, no. NCT02993341.

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