INTRODUCTION: This study aims prospectively to assess perioperative measurement of Troponin T, a marker of myocardial injury, as a predictor of morbidity and mortality in patients undergoing surgery for fractured neck of femur. METHOD: All patients aged 65 years and over presenting with a fractured neck of femur over a 4-month period were initially included. Exclusion criteria were renal failure, polymyositis and conservative fracture management. Troponin T levels were measured on admission, day 1 and 2 post-surgery. According to local protocol, a level of >0.03 ng/mL was considered to be raised. Adverse outcome measures were cardiorespiratory events (myocardial infarction, congestive cardiac failure, unstable angina, major arrhythmias requiring treatment and pulmonary embolism), death and length of inpatient stay. RESULTS: One hundred and twenty-nine patients presented with femoral neck fractures. 108 patients were included after application of the exclusion criteria. 42 (39%) showed a Troponin rise. Of these, 25 sustained one or more outcome complications versus seven with no rise (p<0.001). The mean hospital stay was 25.7 days for patients with elevated Troponin, 18.3 days in the normal group (p<0.012). There were nine deaths in the raised Troponin group, and five with no rise (p<0.05). DISCUSSION: The principle causes of early death after hip fracture surgery are cardiac failure and myocardial infarction. Troponin T is a sensitive enzymatic marker of myocardial injury. The association between raised Troponin and hip fractures has not previously been made. In our series, 39% showed a perioperative Troponin rise. This was significantly associated with increased morbidity, mortality and longer hospitalisation. Many patients appear to be having silent events, causing significant morbidity. We recommend Troponin measurement in all patients to identify this risk and allow appropriate optimisation measures.
INTRODUCTION: This study aims prospectively to assess perioperative measurement of Troponin T, a marker of myocardial injury, as a predictor of morbidity and mortality in patients undergoing surgery for fractured neck of femur. METHOD: All patients aged 65 years and over presenting with a fractured neck of femur over a 4-month period were initially included. Exclusion criteria were renal failure, polymyositis and conservative fracture management. Troponin T levels were measured on admission, day 1 and 2 post-surgery. According to local protocol, a level of >0.03 ng/mL was considered to be raised. Adverse outcome measures were cardiorespiratory events (myocardial infarction, congestive cardiac failure, unstable angina, major arrhythmias requiring treatment and pulmonary embolism), death and length of inpatient stay. RESULTS: One hundred and twenty-nine patients presented with femoral neck fractures. 108 patients were included after application of the exclusion criteria. 42 (39%) showed a Troponin rise. Of these, 25 sustained one or more outcome complications versus seven with no rise (p<0.001). The mean hospital stay was 25.7 days for patients with elevated Troponin, 18.3 days in the normal group (p<0.012). There were nine deaths in the raised Troponin group, and five with no rise (p<0.05). DISCUSSION: The principle causes of early death after hip fracture surgery are cardiac failure and myocardial infarction. Troponin T is a sensitive enzymatic marker of myocardial injury. The association between raised Troponin and hip fractures has not previously been made. In our series, 39% showed a perioperative Troponin rise. This was significantly associated with increased morbidity, mortality and longer hospitalisation. Many patients appear to be having silent events, causing significant morbidity. We recommend Troponin measurement in all patients to identify this risk and allow appropriate optimisation measures.
Authors: Anne Ruth Bass; Tomás Rodriguez; Gina Hyun; Francisco Gerardo Santiago; Jacqueline Ilji Kim; Scott Christopher Woller; Brian Foster Gage Journal: Int Orthop Date: 2015-07-09 Impact factor: 3.075
Authors: Brandon S Oberweis; Nathaniel R Smilowitz; Swetha Nukala; Andrew Rosenberg; Jinfeng Xu; Steven Stuchin; Richard Iorio; Thomas Errico; Martha J Radford; Jeffrey S Berger Journal: Am J Cardiol Date: 2015-03-23 Impact factor: 2.778
Authors: K J Sheehan; E M Guerrero; D Tainter; B Dial; R Milton-Cole; J A Blair; J Alexander; P Swamy; L Kuramoto; P Guy; J P Bettger; B Sobolev Journal: Osteoporos Int Date: 2019-04-29 Impact factor: 4.507
Authors: Jeanne M Huddleston; Rachel E Gullerud; Fantley Smither; Paul M Huddleston; Dirk R Larson; Michael P Phy; L Joseph Melton; Veronique L Roger Journal: J Am Geriatr Soc Date: 2012-10-30 Impact factor: 5.562